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General NPI Number Information
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NPI Number | 1306150149
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Entity Type | Organization
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Legal Business Name | MIZUTA MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 08/04/2010
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Last Update Date | 08/04/2010
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Provider Practice Location Address
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Address Line | 3655 LOMITA BLVD STE 115
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City | TORRANCE
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State | CA
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Zip | 90505-1906
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Country | US
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Telephone | 310-791-9696
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Fax | 310-791-9646
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Provider Business Mailing Address
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Address Line | 3655 LOMITA BLVD STE 115
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City | TORRANCE
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State | CA
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Zip | 90505-1906
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Country | US
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Telephone | 310-791-9696
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Fax | 310-791-9646
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AKIHIRO MIZUTA
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Credential | D.O.
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Telephone | 310-791-9696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A5290
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License Number State | CA
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