Individual
ERICSON MUTSUO HIROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2823 FRESNO ST, FRESNO, CA 93721-1324
(559) 443-2682
(559) 443-2681
Mailing address
2625 E DIVISADERO ST, FRESNO, CA 93721-1431
(559) 443-2682
(559) 443-2681
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
61760
CA
363AM0700X
Medical Physician Assistant
Primary
61760
CA
363AS0400X
Surgical Physician Assistant
61760
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/10/2021
Last updated
11/01/2022
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