Provider Demographics
NPI:1316370760
Name:PAKSIMA, MICHAEL AHMAD (OTC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:AHMAD
Last Name:PAKSIMA
Suffix:
Gender:M
Credentials:OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23560 CRENSHAW BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5233
Mailing Address - Country:US
Mailing Address - Phone:310-784-2355
Mailing Address - Fax:310-517-1817
Practice Address - Street 1:23560 CRENSHAW BLVD STE 102
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5233
Practice Address - Country:US
Practice Address - Phone:310-784-2355
Practice Address - Fax:310-517-1817
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11-1109246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other