MEDICARE: OCEAN VIEW SPECIALISTS MEDICAL AND SURGICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	A41262	CA

General Provider Information

NPI Number	:	1487723672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEAN VIEW SPECIALISTS MEDICAL AND SURGICAL GROUP

Provider Business Mailing Address
First Line	:	11961 VENICE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-3905
Country	:	US
Telephone Number	:	310-391-7143
Fax Number	:

Provider Business Practice Location Address
First Line	:	11961 VENICE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-3905
Country	:	US
Telephone Number	:	310-391-7143
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AUGUSTO ROJAS
Credential	:	M.D.
Telephone Number	:	310-391-7143

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	08/22/2020

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