Provider Demographics
NPI:1134389935
Name:HAMAMOTO-DERESH, SUZUKO (CMT)
Entity type:Individual
Prefix:MRS
First Name:SUZUKO
Middle Name:
Last Name:HAMAMOTO-DERESH
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:883 SNEATH LN
Mailing Address - Street 2:SUITE 221
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-2409
Mailing Address - Country:US
Mailing Address - Phone:650-872-3253
Mailing Address - Fax:650-872-3253
Practice Address - Street 1:883 SNEATH LN
Practice Address - Street 2:SUITE 221
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-2409
Practice Address - Country:US
Practice Address - Phone:850-438-0621
Practice Address - Fax:650-872-3253
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-15
Last Update Date:2008-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANO STATE LICENSE REQ172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist