Provider Demographics
NPI:1184364309
Name:HOMMA, SHINICHI
Entity type:Individual
Prefix:
First Name:SHINICHI
Middle Name:
Last Name:HOMMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 MONTEREY RD APT D
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-3594
Mailing Address - Country:US
Mailing Address - Phone:323-895-3300
Mailing Address - Fax:
Practice Address - Street 1:228 MONTEREY RD APT D
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-3594
Practice Address - Country:US
Practice Address - Phone:323-895-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician