Provider Demographics
NPI:1205136181
Name:ERIC T. HISAKA, M.D., INC
Entity type:Organization
Organization Name:ERIC T. HISAKA, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:T
Authorized Official - Last Name:HISAKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-463-1809
Mailing Address - Street 1:5720 STONERIDGE MALL RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-2828
Mailing Address - Country:US
Mailing Address - Phone:925-463-1809
Mailing Address - Fax:925-463-0748
Practice Address - Street 1:5720 STONERIDGE MALL RD
Practice Address - Street 2:SUITE 130
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-2828
Practice Address - Country:US
Practice Address - Phone:925-463-1809
Practice Address - Fax:925-463-0748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty