Healthcare Provider Details

I. General information

NPI: 1780257782
Provider Name (Legal Business Name): CLEAR MOUNTAIN MEDICAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5315 TORRANCE BLVD STE B-1
TORRANCE CA
90503-4011
US

IV. Provider business mailing address

1212 5TH ST STE 1-432
SANTA MONICA CA
90401-1400
US

V. Phone/Fax

Practice location:
  • Phone: 714-932-7444
  • Fax:
Mailing address:
  • Phone: 714-932-7444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DEREK SUSUMU MORIYAMA
Title or Position: CEO
Credential: MD
Phone: 714-932-7444