Provider Demographics
NPI:1154483915
Name:IWASAKI, OMI (PT, DPT, OCS, ATC)
Entity Type:Individual
Prefix:MR
First Name:OMI
Middle Name:
Last Name:IWASAKI
Suffix:
Gender:M
Credentials:PT, DPT, OCS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18400 AVALON BLVD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-2172
Mailing Address - Country:US
Mailing Address - Phone:310-630-2290
Mailing Address - Fax:
Practice Address - Street 1:2020 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 401
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2023
Practice Address - Country:US
Practice Address - Phone:310-573-8866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250442251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic