Provider Demographics
NPI:1639227937
Name:HIROTA, BRIAN ISAMU (RPT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:ISAMU
Last Name:HIROTA
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N EUCLID ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-4115
Mailing Address - Country:US
Mailing Address - Phone:714-517-2238
Mailing Address - Fax:714-490-0220
Practice Address - Street 1:710 N EUCLID ST
Practice Address - Street 2:SUITE 214
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-4115
Practice Address - Country:US
Practice Address - Phone:714-517-2238
Practice Address - Fax:714-490-0220
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT5618225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEE570ZMedicare PIN
CAPT5618Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER