Most Relevant Information
Provider Data
| NPI Number: | 1003484650 |
| Provider Name: | ERICSON MUTSUO HIROSE PA |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | 61760 |
Most Important Dates
| Enumeration Date: | 06/10/2021 |
| Last Updated: | 11/01/2022 |
Provider Practice Location
2823 FRESNO ST
FRESNO
CA
937211324
Practice Location Phone/Fax
| Phone: | 5594432682 |
| Fax: | 5594432681 |
Provider Mailing Location
2625 E DIVISADERO ST
FRESNO
CA
937211431
Provider Mailing Phone/Fax
| Phone: | 5594432682 |
| Fax: | 5594432681 |