Provider Demographics
NPI:1730518572
Name:TOMOL MEDICAL, INC., A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:TOMOL MEDICAL, INC., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAULE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-644-4477
Mailing Address - Street 1:2980 N BEVERLY GLEN CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1726
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:888-431-8819
Practice Address - Street 1:3400 LOMA VISTA RD
Practice Address - Street 2:SUITE 9
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3033
Practice Address - Country:US
Practice Address - Phone:805-644-4477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOMOL MEDICAL, INC., A PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-02
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84131332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site