Provider Demographics
NPI:1851311617
Name:VISTA WAY OB-GYN MEDICAL GROUP, IN.C.
Entity Type:Organization
Organization Name:VISTA WAY OB-GYN MEDICAL GROUP, IN.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-758-1220
Mailing Address - Street 1:3998 VISTA WAY STE C202
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4518
Mailing Address - Country:US
Mailing Address - Phone:760-758-1220
Mailing Address - Fax:760-758-9735
Practice Address - Street 1:3998 VISTA WAY STE C202
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4518
Practice Address - Country:US
Practice Address - Phone:760-758-1220
Practice Address - Fax:760-758-9735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ81157ZMedicaid
CAW4186Medicare ID - Type Unspecified