Provider Demographics
NPI:1477502045
Name:HIRATA, SHAROLYN S (CRNA)
Entity Type:Individual
Prefix:
First Name:SHAROLYN
Middle Name:S
Last Name:HIRATA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19580 MAYFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-6618
Mailing Address - Country:US
Mailing Address - Phone:714-536-9860
Mailing Address - Fax:
Practice Address - Street 1:19580 MAYFIELD CIRCLE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACG
Practice Address - State:CA
Practice Address - Zip Code:92648-6618
Practice Address - Country:US
Practice Address - Phone:920-303-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55373367500000X
KS55373367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200364780AMedicaid
KS145048OtherBCBS
CA042761OtherCRNA CERT
P00155113OtherRR MEDICARE GROUP CQ2302
KS200364780AMedicaid