Doctor Name: | OWEN SHIBATA |
NPI Number: | 1396019303 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | G66533 |
Business Practice Address: | 2100 Embarcadero Oakland, CA - 946065302 |
Business Phone Number: | 8002684420 |
Business Fax Number: | |
Mailing Address: | 632 Palomino Dr, PLEASANTON |
State: | CA |
Postal Code: | 945666814 |
Phone Number: | 9253995422 |
Fax Number: | |
NPI Enumeration Date: | 03/08/2012 |
NPI Last Update Date: | 03/08/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | G66533 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |