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General NPI Number Information
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NPI Number | 1477786291
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Entity Type | Organization
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Legal Business Name | THOMAS G HIROSE, M.D. APC LABORATORY
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Dates
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Enumeration Date | 08/27/2009
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Last Update Date | 08/27/2009
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Provider Practice Location Address
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Address Line | 647 CAMINO DE LOS MARES SUITE 223
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-2807
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Country | US
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Telephone | 949-487-5100
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Fax | 949-487-7065
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Provider Business Mailing Address
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Address Line | 647 CAMINO DE LOS MARES SUITE 223
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-2807
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Country | US
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Telephone | 949-487-5100
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Fax | 949-487-7065
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS G. HIROSE
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Credential | M.D,
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Telephone | 949-487-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | G66676
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License Number State | CA
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