Provider Demographics
NPI:1598989550
Name:MICHAEL JAY PAVELOFF M D INC
Entity Type:Organization
Organization Name:MICHAEL JAY PAVELOFF M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MGR
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-869-2600
Mailing Address - Street 1:PO BOX 9819
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93389-9819
Mailing Address - Country:US
Mailing Address - Phone:805-682-4459
Mailing Address - Fax:
Practice Address - Street 1:1933 CLIFF DR
Practice Address - Street 2:SUITE 29
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93109-1520
Practice Address - Country:US
Practice Address - Phone:805-682-4459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78490207W00000X, 208600000X
CA4469950001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4557534OtherAETNA
CA4557534OtherAETNA
CA4469950002Medicare NSC
CAF81024Medicare UPIN