Healthcare Provider Details

I. General information

NPI: 1437148400
Provider Name (Legal Business Name): KOMAKI ENTERPRISES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8575 LOS COCHES RD SUITE 5
EL CAJON CA
92021-8815
US

IV. Provider business mailing address

8575 LOS COCHES RD SUITE 5
EL CAJON CA
92021-8815
US

V. Phone/Fax

Practice location:
  • Phone: 619-561-5602
  • Fax: 619-561-5933
Mailing address:
  • Phone: 619-561-5602
  • Fax: 619-561-5933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPHY42161
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY42161
License Number StateCA

VIII. Authorized Official

Name: DR. EDWARD SAIJI KOMAKI
Title or Position: PRESIDENT
Credential: PHARM D
Phone: 619-561-5602