Provider Demographics
NPI:1891667325
Name:KAWAMOTO, DEIDRE (FNP-C)
Entity type:Individual
Prefix:
First Name:DEIDRE
Middle Name:
Last Name:KAWAMOTO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10580 BRUNS DR
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-1413
Mailing Address - Country:US
Mailing Address - Phone:714-722-0203
Mailing Address - Fax:
Practice Address - Street 1:10580 BRUNS DR
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-1413
Practice Address - Country:US
Practice Address - Phone:714-722-0203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF09250798363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty