Provider Demographics
NPI:1174585020
Name:MIZUGUCHI, KAORU ANNETTE (MD PHD MMSC)
Entity type:Individual
Prefix:
First Name:KAORU
Middle Name:ANNETTE
Last Name:MIZUGUCHI
Suffix:
Gender:F
Credentials:MD PHD MMSC
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:K
Other - Last Name:MIZUGUCHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD PHD
Mailing Address - Street 1:PO BOX 232410
Mailing Address - Street 2:DEPARTMENT OF ANESTHESIOLOGY
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-2410
Mailing Address - Country:US
Mailing Address - Phone:619-543-5754
Mailing Address - Fax:
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:BWH, DEPARTMENT OF ANESTHESIOLOGY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-732-8218
Practice Address - Fax:617-277-2192
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA160087207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology