Healthcare Provider Details

I. General information

NPI: 1891092862
Provider Name (Legal Business Name): OZAKI, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2011
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S OCEAN DR APT 17D
HOLLYWOOD FL
33019-2427
US

IV. Provider business mailing address

1600 S OCEAN DR APT 17D
HOLLYWOOD FL
33019-2427
US

V. Phone/Fax

Practice location:
  • Phone: 954-927-5738
  • Fax:
Mailing address:
  • Phone: 954-927-5738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOS 8830
License Number StateFL

VIII. Authorized Official

Name: ROBERT OZAKI
Title or Position: PRESIDENT
Credential: D.O.
Phone: 954-927-5738