Provider Demographics
NPI:1629532791
Name:HIRATA, KAORY MIZRAIM
Entity Type:Individual
Prefix:
First Name:KAORY
Middle Name:MIZRAIM
Last Name:HIRATA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAORY
Other - Middle Name:MIZRAIM
Other - Last Name:USSERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:922 22ND ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-1904
Mailing Address - Country:US
Mailing Address - Phone:619-847-9474
Mailing Address - Fax:
Practice Address - Street 1:8885 RIO SAN DIEGO DR STE 301
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1610
Practice Address - Country:US
Practice Address - Phone:619-345-4611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No171M00000XOther Service ProvidersCase Manager/Care Coordinator