Healthcare Provider Details

I. General information

NPI: 1497748149
Provider Name (Legal Business Name): MARK B OECHSLI PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4531 ALAMO ST SIERRA VISTA FAMILY MEDICAL CLINIC
SIMI VALLEY CA
93063
US

IV. Provider business mailing address

5738 SKYVIEW WAY UNIT G
AGOURA HILLS CA
91301
US

V. Phone/Fax

Practice location:
  • Phone: 805-520-3248
  • Fax: 805-579-6082
Mailing address:
  • Phone: 818-706-0483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA14447
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: