Provider Demographics
NPI:1851599229
Name:TOMITA1, SATOKO
Entity Type:Individual
Prefix:
First Name:SATOKO
Middle Name:
Last Name:TOMITA1
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9005 PRINCETON WAY
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4639
Mailing Address - Country:US
Mailing Address - Phone:714-826-1390
Mailing Address - Fax:
Practice Address - Street 1:14284 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-4562
Practice Address - Country:US
Practice Address - Phone:714-891-7291
Practice Address - Fax:714-891-4195
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 10672171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist