Provider Demographics
NPI:1477699148
Name:SHIMIZU, HIDEO (PHD)
Entity Type:Individual
Prefix:DR
First Name:HIDEO
Middle Name:
Last Name:SHIMIZU
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 E 3RD AVE
Mailing Address - Street 2:# 201
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4201
Mailing Address - Country:US
Mailing Address - Phone:760-740-8690
Mailing Address - Fax:
Practice Address - Street 1:127 E 3RD AVE
Practice Address - Street 2:# 201
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4201
Practice Address - Country:US
Practice Address - Phone:760-740-8690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19666103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical