Healthcare Provider Details

I. General information

NPI: 1881419612
Provider Name (Legal Business Name): OKAMOTO AND BIGLEY HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 BELLEFONTAINE ST STE 204
PASADENA CA
91105-3132
US

IV. Provider business mailing address

50 BELLEFONTAINE ST STE 204
PASADENA CA
91105-3132
US

V. Phone/Fax

Practice location:
  • Phone: 626-440-9095
  • Fax:
Mailing address:
  • Phone: 626-440-9095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GERI LYNN GUNSALUS OKAMOTO
Title or Position: PARTNER
Credential: DDS
Phone: 626-440-9095