Individual
TETSUO ISHIMORI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2901 SILLECT AVE, SUITE 100, BAKERSFIELD, CA 93308-6370
(661) 323-8384
(661) 323-9326
Mailing address
PO BOX 1139, BAKERSFIELD, CA 93302-1139
(661) 323-8384
(661) 323-9326
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
A30114
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A301141
INDIVIDUAL PTAN
CA
01
—
060012146
RAILROAD MEDICARE
CA
01
—
953511288
TAX ID
CA
Enumeration date
06/08/2007
Last updated
05/06/2009
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