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General NPI Number Information
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NPI Number | 1487098117
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Entity Type | Organization
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Legal Business Name | IBODY, INC.
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Dates
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Enumeration Date | 04/24/2013
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Last Update Date | 04/24/2013
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Provider Practice Location Address
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Address Line | 956 HUNTINGTON DR
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City | SAN MARINO
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State | CA
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Zip | 91108-1825
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Country | US
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Telephone | 626-628-6095
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Fax |
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Provider Business Mailing Address
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Address Line | 956 HUNTINGTON DR
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City | SAN MARINO
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State | CA
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Zip | 91108-1825
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Country | US
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Telephone | 626-628-6095
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | DR. ROBERTO TOSTADO
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Credential | M.D.
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Telephone | 626-628-6095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 102111616
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License Number State | CA
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