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General NPI Number Information
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NPI Number | 1992005474
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Entity Type | Organization
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Legal Business Name | TOMIO T. ODAMA, M.D., INC.
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Dates
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Enumeration Date | 10/29/2010
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Last Update Date | 03/25/2015
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Provider Practice Location Address
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Address Line | 1117 W TOKAY ST SUITE A
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City | LODI
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State | CA
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Zip | 95240-3844
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Country | US
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Telephone | 209-333-2551
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Fax | 209-333-8274
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Provider Business Mailing Address
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Address Line | 1117 W TOKAY ST SUITE A
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City | LODI
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State | CA
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Zip | 95240-3844
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Country | US
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Telephone | 209-333-2551
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Fax | 209-333-8274
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TOMIO THOMAS ODAMA
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Credential | M.D.
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Telephone | 209-333-2551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G28380
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License Number State | CA
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