Healthcare Provider Details

I. General information

NPI: 1114998598
Provider Name (Legal Business Name): ALAN ROBERT MIZUTANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 SUPERIOR AVE STE 114
NEWPORT BEACH CA
92663-3639
US

IV. Provider business mailing address

PO BOX 25033
SANTA ANA CA
92799-5033
US

V. Phone/Fax

Practice location:
  • Phone: 949-646-6999
  • Fax: 949-646-9699
Mailing address:
  • Phone: 714-347-1010
  • Fax: 714-347-1082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG62366
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG62366
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: