Healthcare Provider Details

I. General information

NPI: 1609558865
Provider Name (Legal Business Name): HOPE EMERY HIZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

754 CLINTON AVE
BRIDGEPORT CT
06604-2369
US

IV. Provider business mailing address

754 CLINTON AVE
BRIDGEPORT CT
06604-2369
US

V. Phone/Fax

Practice location:
  • Phone: 203-923-2204
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number6214
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: