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General NPI Number Information
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NPI Number | 1205387719
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Entity Type | Organization
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Legal Business Name | COURTNEY MIZUHARA-CHENG DO MSHS INC
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Dates
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Enumeration Date | 10/19/2016
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Last Update Date | 10/19/2016
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Provider Practice Location Address
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Address Line | 21201 VICTORY BLVD STE 154
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City | CANOGA PARK
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State | CA
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Zip | 91303-4051
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Country | US
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Telephone | 818-661-6367
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Fax |
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Provider Business Mailing Address
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Address Line | 21201 VICTORY BLVD STE 154
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City | CANOGA PARK
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State | CA
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Zip | 91303-4051
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Country | US
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Telephone | 818-661-6367
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Fax |
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Authorized Official
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Title or Position | DMINISTRATOR
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Name | VIRGINIA M NEWSOME
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Credential | ADMINISTRATOR
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Telephone | 304-940-1395
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A10710
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License Number State | CA
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