Basic Information
| Provider Information | |||||||||
| NPI: | 1437577517 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MITSUNAGA | ||||||||
| FirstName: | MYLES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1356 LUSITANA ST | ||||||||
| Address2: | STE. 510 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968132409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085862890 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4860 Y ST STE 3100 | ||||||||
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| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958172307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167032108 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2014 | ||||||||
| LastUpdateDate: | 02/08/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | A140178 | CA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.