Healthcare Provider Details

I. General information

NPI: 1336059849
Provider Name (Legal Business Name): DR TOLA TSARUMI MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 W GREEN ST STE 100
PASADENA CA
91105-4131
US

IV. Provider business mailing address

135 W GREEN ST STE 100
PASADENA CA
91105-4131
US

V. Phone/Fax

Practice location:
  • Phone: 617-467-0312
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: OMOTOLA TSARUMI
Title or Position: OWNER
Credential:
Phone: 617-668-1239