Provider Demographics
NPI:1548381452
Name:PACIFIC OAKS MEDICAL GROUP LABORATORIES
Entity Type:Organization
Organization Name:PACIFIC OAKS MEDICAL GROUP LABORATORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCARSELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-652-2562
Mailing Address - Street 1:7855 HASKELL AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-1900
Mailing Address - Country:US
Mailing Address - Phone:800-920-2022
Mailing Address - Fax:
Practice Address - Street 1:7855 HASKELL AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-1900
Practice Address - Country:US
Practice Address - Phone:800-920-2022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF 10363291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory