Individual
ZACHARY MITCHELL KIMO MITSUI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7311 BLUESTONE RD, SAN ANTONIO, TX 78249
(808) 384-4793
Mailing address
7311 BLUESTONE RD, SAN ANTONIO, TX 78249
(808) 384-4793
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT7805
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
44868893
DRIVER'S LICENSE NUMBER
TX
Enumeration date
10/15/2020
Last updated
10/15/2020
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