Healthcare Provider Details

I. General information

NPI: 1679556062
Provider Name (Legal Business Name): HIROMI OZAWA P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 01/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3771 RIO RD STE 110
CARMEL CA
93923-8671
US

IV. Provider business mailing address

3771 RIO RD STE 110
CARMEL CA
93923-8671
US

V. Phone/Fax

Practice location:
  • Phone: 831-293-8094
  • Fax: 831-250-5122
Mailing address:
  • Phone: 831-293-8094
  • Fax: 831-250-5122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT30115
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: