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General NPI Number Information
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NPI Number | 1962524231
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Entity Type | Organization
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Legal Business Name | STATE-OF-THE-ART TECHNOLOGIES INC.
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 03/13/2012
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Provider Practice Location Address
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Address Line | 4019 W ROSECRANS AVE
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City | HAWTHORNE
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State | CA
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Zip | 90250-7913
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Country | US
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Telephone | 310-675-9121
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Fax |
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Provider Business Mailing Address
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Address Line | 4019 W ROSECRANS AVE
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City | HAWTHORNE
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State | CA
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Zip | 90250-7913
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Country | US
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Telephone | 310-675-9121
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. OSEMWOTA OMOIGUI
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Credential | MD
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Telephone | 310-675-9121
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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 | A48906
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License Number State | CA
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