Healthcare Provider Details

I. General information

NPI: 1104403963
Provider Name (Legal Business Name): HALEY JOY OOSTERHOUSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E SPRING ST STE 1
LONG BEACH CA
90806-1625
US

IV. Provider business mailing address

1100 PARK PL
SAN MATEO CA
94403-1599
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-0050
  • Fax: 562-933-0079
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA196389
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA196389
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: