Individual provider · Type 1 NPI

Ericson Mutsuo Hirose, PA

Medical Physician Assistant · Fresno, CA

NPI number 1003484650 Active

Practice location

2823 Fresno St
Fresno, CA 93721-1324

Call (559) 443-2682 Map

Fax (559) 443-2681

Mailing address

2625 E Divisadero St
Fresno, CA 93721-1431

Specialties and licenses

TaxonomyCodeLicense
Physician Assistant 363A00000X61760 (CA)
Surgical Physician Assistant 363AS0400X61760 (CA)
Student in an Organized Health Care Education/Training Program 390200000XNone listed
Medical Physician Assistant Primary 363AM0700X61760 (CA)

Medical Physician Assistant: Definition to come...

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About NPI 1003484650

Ericson Mutsuo Hirose, PA's National Provider Identifier is 1003484650, issued on Jun 10, 2021. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Fresno, CA. The record was last updated on Nov 1, 2022.