Provider Demographics
NPI:1730303637
Name:ITAGAKI, CECILE C (NP)
Entity type:Individual
Prefix:
First Name:CECILE
Middle Name:C
Last Name:ITAGAKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:455 S MAIN ST
Mailing Address - Street 2:PSF PULMONOLOGY
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3835
Mailing Address - Country:US
Mailing Address - Phone:714-532-8620
Mailing Address - Fax:714-289-4072
Practice Address - Street 1:455 S MAIN ST
Practice Address - Street 2:PSF PULMONOLOGY
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3835
Practice Address - Country:US
Practice Address - Phone:714-532-8620
Practice Address - Fax:714-289-4072
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA7734363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner