Provider Demographics
NPI:1275622748
Name:THOMAS G HIROSE MD APC
Entity Type:Organization
Organization Name:THOMAS G HIROSE MD APC
Other - Org Name:TRANSFUSION MEDICINE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROJECT MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-388-2364
Mailing Address - Street 1:647 CAMINO DE LOS MARES
Mailing Address - Street 2:SUITE 223
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2825
Mailing Address - Country:US
Mailing Address - Phone:310-373-5700
Mailing Address - Fax:310-373-0600
Practice Address - Street 1:24445 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6562
Practice Address - Country:US
Practice Address - Phone:310-373-5700
Practice Address - Fax:310-373-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G666760Medicaid
CA00G666760Medicaid
CAW20143AMedicare PIN
CAZZZ06466ZMedicare PIN
CAW20143Medicare PIN