Provider Demographics
NPI:1417149006
Name:BRUCE A OURIEFF MD INC.
Entity Type:Organization
Organization Name:BRUCE A OURIEFF MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-922-5749
Mailing Address - Street 1:821 E CHAPEL ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4617
Mailing Address - Country:US
Mailing Address - Phone:805-922-5749
Mailing Address - Fax:805-928-7823
Practice Address - Street 1:821 E CHAPEL ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4617
Practice Address - Country:US
Practice Address - Phone:805-922-5749
Practice Address - Fax:805-928-7823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44779174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G447790Medicaid
CA00G447790Medicaid
CAW19274Medicare PIN