Healthcare Provider Details

I. General information

NPI: 1427078286
Provider Name (Legal Business Name): VISTA WAY OB-GYN MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 SAXONY RD STE 205
ENCINITAS CA
92024-2787
US

IV. Provider business mailing address

3998 VISTA WAY STE C202
OCEANSIDE CA
92056-4518
US

V. Phone/Fax

Practice location:
  • Phone: 760-635-1880
  • Fax: 760-635-1887
Mailing address:
  • Phone: 760-758-1220
  • Fax: 760-758-9735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MICHELLE MOORE
Title or Position: OFFICE MANAGER
Credential:
Phone: 760-758-1220