Provider Demographics
NPI:1427453182
Name:TANAKA, BARBARA HITOMI (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:HITOMI
Last Name:TANAKA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5705 FRIARS RD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-1805
Mailing Address - Country:US
Mailing Address - Phone:408-891-4653
Mailing Address - Fax:
Practice Address - Street 1:11515 EL CAMINO REAL
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-3038
Practice Address - Country:US
Practice Address - Phone:858-794-6363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20796363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health