Basic Information
| Provider Information | |||||||||
| NPI: | 1215250824 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OSATO MEDICAL CLINIC, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3440 LOMITA BLVD | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905054801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105348200 | ||||||||
| FaxNumber: | 3105348265 | ||||||||
| Practice Location | |||||||||
| Address1: | 3440 LOMITA BLVD | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905054801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105348200 | ||||||||
| FaxNumber: | 3105348265 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2010 | ||||||||
| LastUpdateDate: | 03/10/2010 | ||||||||
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| AuthorizedOfficialLastName: | OSATO | ||||||||
| AuthorizedOfficialFirstName: | MASAHARU | ||||||||
| AuthorizedOfficialMiddleName: | MIKE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/ PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 3105348200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0100X | NP18903 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Health Service |
No ID Information.