Provider Demographics
NPI:1124788526
Name:HIRMIZ, BRIAN G
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:G
Last Name:HIRMIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3072 RANCHO DIEGO CIR
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-5114
Mailing Address - Country:US
Mailing Address - Phone:619-772-9530
Mailing Address - Fax:
Practice Address - Street 1:3745 AVOCADO BLVD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-7301
Practice Address - Country:US
Practice Address - Phone:619-485-8071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301505225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist