Provider Demographics
NPI:1821336009
Name:KOUZU, HISAKA HILARY
Entity Type:Individual
Prefix:
First Name:HISAKA
Middle Name:HILARY
Last Name:KOUZU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-1847
Mailing Address - Country:US
Mailing Address - Phone:510-232-0874
Mailing Address - Fax:510-232-8652
Practice Address - Street 1:1313 CUTTING BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-2554
Practice Address - Country:US
Practice Address - Phone:510-232-0874
Practice Address - Fax:510-232-8652
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)