Healthcare Provider Details

I. General information

NPI: 1083044192
Provider Name (Legal Business Name): OHNI CLINICAL SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2013
Last Update Date: 11/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8631 W 3RD ST SUITE 945E
LOS ANGELES CA
90048-5901
US

IV. Provider business mailing address

PO BOX 45345
LOS ANGELES CA
90045-0345
US

V. Phone/Fax

Practice location:
  • Phone: 310-657-0123
  • Fax: 310-657-0142
Mailing address:
  • Phone: 310-657-0123
  • Fax: 310-657-0142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number070788
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA64640
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number21319
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA64640
License Number StateCA

VIII. Authorized Official

Name: MRS. KIM YVETTE GALES
Title or Position: BUSINESS ADMINISTRATOR
Credential:
Phone: 310-657-0123