Healthcare Provider Details

I. General information

NPI: 1629010319
Provider Name (Legal Business Name): TOMOL MEDICAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 W SANTA CLARA ST
VENTURA CA
93001-2542
US

IV. Provider business mailing address

1072 CASITAS PASS RD #373
CARPINTERIA CA
93013-2109
US

V. Phone/Fax

Practice location:
  • Phone: 805-643-3034
  • Fax: 805-643-3088
Mailing address:
  • Phone: 805-643-3034
  • Fax: 805-643-3094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberG84131
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberG84131
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG84131
License Number StateCA

VIII. Authorized Official

Name: ANN OLSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 805-643-3034