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General NPI Number Information
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NPI Number | 1003315235
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Entity Type | Organization
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Legal Business Name | OCEANUS MEDICAL GROUP INC A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 02/02/2018
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Last Update Date | 01/07/2021
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Provider Practice Location Address
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Address Line | 8436 W 3RD ST STE 800
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City | LOS ANGELES
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State | CA
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Zip | 90048-4100
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Country | US
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Telephone | 310-448-3459
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3129
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City | TORRANCE
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State | CA
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Zip | 90510-3129
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Country | US
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Telephone | 310-792-3914
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Fax | 855-898-4055
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANIEL LODER
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Credential | MD
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Telephone | 310-448-3459
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | A91446
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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