Healthcare Provider Details

I. General information

NPI: 1417618794
Provider Name (Legal Business Name): TOMOMI KURITA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2022
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12001 EUCLID ST
GARDEN GROVE CA
92840-3332
US

IV. Provider business mailing address

12001 EUCLID ST
GARDEN GROVE CA
92840-3332
US

V. Phone/Fax

Practice location:
  • Phone: 714-530-1071
  • Fax: 714-530-2637
Mailing address:
  • Phone: 714-530-1071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH84935
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: