Provider Demographics
NPI:1225127566
Name:PACIFIC OAKS MEDICAL GROUP & SUBSIDIARY
Entity Type:Organization
Organization Name:PACIFIC OAKS MEDICAL GROUP & SUBSIDIARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCARSELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-652-2562
Mailing Address - Street 1:150 N ROBERTSON BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2145
Mailing Address - Country:US
Mailing Address - Phone:310-652-2562
Mailing Address - Fax:310-967-3698
Practice Address - Street 1:150 N ROBERTSON BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2142
Practice Address - Country:US
Practice Address - Phone:310-652-2562
Practice Address - Fax:310-967-3698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW6439BMedicare ID - Type Unspecified