Provider Demographics
NPI:1457629107
Name:OPUS MEDICAL CENTER INC.
Entity Type:Organization
Organization Name:OPUS MEDICAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GHASSEMI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-548-5656
Mailing Address - Street 1:1534 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-4402
Mailing Address - Country:US
Mailing Address - Phone:310-548-5656
Mailing Address - Fax:
Practice Address - Street 1:1534 W 25TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-4402
Practice Address - Country:US
Practice Address - Phone:310-548-5656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23816111N00000X
CAC 51512174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty