Healthcare Provider Details

I. General information

NPI: 1922237809
Provider Name (Legal Business Name): SHAWNA AKIKO HIRATA JOHNSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHAWNA A HIRATA

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4290 POLK AVENUE
SAN DIEGO CA
92105
US

IV. Provider business mailing address

4290 POLK AVENUE
SAN DIEGO CA
92105
US

V. Phone/Fax

Practice location:
  • Phone: 619-563-0250
  • Fax: 858-633-4681
Mailing address:
  • Phone: 619-563-0250
  • Fax: 858-633-4681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95002518
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: