Basic Information
| Provider Information | |||||||||
| NPI: | 1174585020 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIZUGUCHI | ||||||||
| FirstName: | KAORU | ||||||||
| MiddleName: | ANNETTE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD PHD MMSC | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | MIZUGUCHI | ||||||||
| OtherFirstName: | ANNETTE | ||||||||
| OtherMiddleName: | K | ||||||||
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| OtherCredential: | MD PHD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 232410 | ||||||||
| Address2: | DEPARTMENT OF ANESTHESIOLOGY | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921932410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195435754 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 75 FRANCIS ST | ||||||||
| Address2: | BWH, DEPARTMENT OF ANESTHESIOLOGY | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021156110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177328218 | ||||||||
| FaxNumber: | 6172772192 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2006 | ||||||||
| LastUpdateDate: | 05/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 160087 | MA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.