Basic Information
| Provider Information | |||||||||
| NPI: | 1821041161 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ISHIMARU | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | SHIGERU | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26730 CROWN VALLEY PARKWAY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926918001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9493642154 | ||||||||
| FaxNumber: | 9493642110 | ||||||||
| Practice Location | |||||||||
| Address1: | 26730 CROWN VALLEY PARKWAY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926918001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9493642154 | ||||||||
| FaxNumber: | 9493642110 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | G27381 | CA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.