| Cynthia Kodama, Inc | |
|
2104 Wilshire Blvd Santa Monica CA 90403-5704 | |
| (310) 882-8258 | |
| Not Available |
| Full Name | Cynthia Kodama, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2104 Wilshire Blvd, Santa Monica, California |
| Authorized Official Name and Position | Cynthia Kodama (OWNER) |
| Authorized Official Contact | 3237919867 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cynthia Kodama, Inc 1363 Pebble Hurst St Monterey Park CA 91754-4422 Ph: (323) 791-9867 | Cynthia Kodama, Inc 2104 Wilshire Blvd Santa Monica CA 90403-5704 Ph: (310) 882-8258 |
| NPI Number | 1003231101 |
|---|---|
| Provider Enumeration Date | 02/26/2014 |
| Last Update Date | 03/14/2014 |
| Medicare PECOS PAC ID | 0547492118 |
|---|---|
| Medicare Enrollment ID | O20140414000655 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003231101 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 20A10411 (California) | Primary |
| Provider Name | Cynthia Kodama |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1013166503 PECOS PAC ID: 4981741238 Enrollment ID: I20091022000566 |
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