Provider Demographics
NPI:1205402617
Name:CALIFORNIA IOM INCORPORATED
Entity Type:Organization
Organization Name:CALIFORNIA IOM INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NAGASAWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-710-1919
Mailing Address - Street 1:2811 WILSHIRE BLVD STE 930
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4803
Mailing Address - Country:US
Mailing Address - Phone:310-710-1919
Mailing Address - Fax:424-238-8362
Practice Address - Street 1:2811 WILSHIRE BLVD STE 930
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4803
Practice Address - Country:US
Practice Address - Phone:310-710-1919
Practice Address - Fax:424-238-8362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory