Provider Demographics
NPI:1033591136
Name:OCEANA SPORTS MEDICINE AND ORTHOPAEDIC CENTER
Entity Type:Organization
Organization Name:OCEANA SPORTS MEDICINE AND ORTHOPAEDIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-448-5451
Mailing Address - Street 1:1232 PERIMETER PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-5924
Mailing Address - Country:US
Mailing Address - Phone:757-448-5451
Mailing Address - Fax:
Practice Address - Street 1:1232 PERIMETER PKWY STE 205
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-5924
Practice Address - Country:US
Practice Address - Phone:757-448-5451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAS566493-5261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center