Provider Demographics
NPI:1003856402
Name:OVI MOAS M D A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:OVI MOAS M D A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:BEATTIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-285-7158
Mailing Address - Street 1:9815 LAS TUNAS DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-2209
Mailing Address - Country:US
Mailing Address - Phone:626-285-7158
Mailing Address - Fax:626-285-9392
Practice Address - Street 1:9815 LAS TUNAS DR
Practice Address - Street 2:
Practice Address - City:TEMPLE CITY
Practice Address - State:CA
Practice Address - Zip Code:91780-2209
Practice Address - Country:US
Practice Address - Phone:626-285-7158
Practice Address - Fax:626-285-9392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35730207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A357300Medicaid
CAA35730Medicare PIN
CA00A357300Medicaid
A27887Medicare UPIN
CAWA35730CMedicare PIN