=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730108374
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT M. OZAKI M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2006
-----------------------------------------------------
Last Update Date | 07/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 420 E 3RD ST SUITE 809
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90013-1644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-687-0424
-----------------------------------------------------
Fax | 213-687-7172
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 420 E 3RD ST SUITE 809
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90013-1644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-687-0424
-----------------------------------------------------
Fax | 213-687-7172
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | G047909
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------