Healthcare Provider Details

I. General information

NPI: 1992999387
Provider Name (Legal Business Name): OA MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 SAWTELLE BLVD SUITE 150
W LOS ANGELES CA
90025
US

IV. Provider business mailing address

1950 SAWTELLE BLVD SUITE 150
W LOS ANGELES CA
90025
US

V. Phone/Fax

Practice location:
  • Phone: 310-996-8500
  • Fax: 310-445-8746
Mailing address:
  • Phone: 310-996-8500
  • Fax: 310-445-8746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG29563
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberG29563
License Number StateCA

VIII. Authorized Official

Name: DR. RICHARD P POLLIS
Title or Position: PRESIDENT
Credential: MD
Phone: 310-996-8500