Provider Demographics
NPI:1992360234
Name:MIZUKI, RIE HONDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:RIE
Middle Name:HONDA
Last Name:MIZUKI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10181 PIMLICO DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-4144
Mailing Address - Country:US
Mailing Address - Phone:562-537-8731
Mailing Address - Fax:
Practice Address - Street 1:11879 DEL AMO BLVD
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-7605
Practice Address - Country:US
Practice Address - Phone:562-537-8731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13498103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical