Provider Demographics
NPI:1437269255
Name:OASIS MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:OASIS MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:A
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-370-4400
Mailing Address - Street 1:PO BOX 7438
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92607-7438
Mailing Address - Country:US
Mailing Address - Phone:909-370-4400
Mailing Address - Fax:909-370-4405
Practice Address - Street 1:1550 E WASHINGTON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-4624
Practice Address - Country:US
Practice Address - Phone:909-370-4400
Practice Address - Fax:909-370-4405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77562208200000X
CAG43151208G00000X
CAPA 18333363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ03406ZMedicare PIN