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General NPI Number Information
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NPI Number | 1588041248
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Entity Type | Organization
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Legal Business Name | COURTNEY MIZUHARA-CHENG, D.O., M.S.H.S., INC.
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Dates
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Enumeration Date | 05/01/2015
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Last Update Date | 05/01/2015
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Provider Practice Location Address
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Address Line | 2901 OCEAN PARK BLVD STE 207
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City | SANTA MONICA
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State | CA
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Zip | 90405-2964
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Country | US
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Telephone | 424-272-6513
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Fax |
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Provider Business Mailing Address
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Address Line | 2901 OCEAN PARK BLVD STE 207
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City | SANTA MONICA
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State | CA
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Zip | 90405-2964
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Country | US
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Telephone | 424-272-6513
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. COURTNEY MIZUHARA-CHENG
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Credential | D.O.
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Telephone | 424-272-6513
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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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