Provider Demographics
NPI:1508893934
Name:HIRAMATSU, MIKA (MD)
Entity Type:Individual
Prefix:DR
First Name:MIKA
Middle Name:
Last Name:HIRAMATSU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22290 FOOTHILL BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-2731
Mailing Address - Country:US
Mailing Address - Phone:510-581-1446
Mailing Address - Fax:510-581-1805
Practice Address - Street 1:22290 FOOTHILL BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-2731
Practice Address - Country:US
Practice Address - Phone:510-581-1446
Practice Address - Fax:510-581-1805
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG70483208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9061025Medicaid
CAG00704830Medicaid