Healthcare Provider Details

I. General information

NPI: 1689279135
Provider Name (Legal Business Name): NAGOMI CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 W CALIFORNIA BLVD
PASADENA CA
91105-3005
US

IV. Provider business mailing address

137 W CALIFORNIA BLVD
PASADENA CA
91105-3005
US

V. Phone/Fax

Practice location:
  • Phone: 626-793-7818
  • Fax:
Mailing address:
  • Phone: 626-793-7818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT RECALDE
Title or Position: PRESIDENT
Credential:
Phone: 626-793-7818