Provider Demographics
NPI:1114998598
Name:MIZUTANI, ALAN ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:ROBERT
Last Name:MIZUTANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25033
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92799-5033
Mailing Address - Country:US
Mailing Address - Phone:714-347-1010
Mailing Address - Fax:714-347-1082
Practice Address - Street 1:1525 SUPERIOR AVE STE 114
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3639
Practice Address - Country:US
Practice Address - Phone:949-646-6999
Practice Address - Fax:949-646-9699
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62366207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G623661Medicaid
CAP01637802 (RIV)Medicare PIN
CA00G623661Medicaid
CABR573 (RIV)Medicare PIN
CAG62366A (OC)Medicare PIN