Healthcare Provider Details

I. General information

NPI: 1205192010
Provider Name (Legal Business Name): MITCHELL K TAGUCHI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 04/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 LOMITA BLVD SUITE 320
TORRANCE CA
90505-4801
US

IV. Provider business mailing address

PO BOX 3098
TORRANCE CA
90510-3098
US

V. Phone/Fax

Practice location:
  • Phone: 310-534-8200
  • Fax:
Mailing address:
  • Phone: 310-792-3914
  • Fax: 855-898-4055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA65921
License Number StateCA

VIII. Authorized Official

Name: MR. MITCHELL KOICHI TAGUCHI
Title or Position: PRESIDENT/ OWNER
Credential: MD
Phone: 310-792-3914