MEDICARE: VISTA WAY OB-GYN MEDICAL GROUP, IN.C.

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	207V00000X	Obstetrics & Gynecology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851311617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISTA WAY OB-GYN MEDICAL GROUP, IN.C.

Provider Business Mailing Address
First Line	:	3998 VISTA WAY STE C202
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-4518
Country	:	US
Telephone Number	:	760-758-1220
Fax Number	:	760-758-9735

Provider Business Practice Location Address
First Line	:	3998 VISTA WAY STE C202
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-4518
Country	:	US
Telephone Number	:	760-758-1220
Fax Number	:	760-758-9735

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. MICHELLE M. MOORE
Credential	:
Telephone Number	:	760-758-1220

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	08/22/2020

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