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General NPI Number Information
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NPI Number | 1033591136
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Entity Type | Organization
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Legal Business Name | OCEANA SPORTS MEDICINE AND ORTHOPAEDIC CENTER
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Dates
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Enumeration Date | 06/24/2015
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Last Update Date | 06/24/2015
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Provider Practice Location Address
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Address Line | 1232 PERIMETER PKWY STE 205
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-5924
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Country | US
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Telephone | 757-448-5451
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Fax |
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Provider Business Mailing Address
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Address Line | 1232 PERIMETER PKWY STE 205
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-5924
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Country | US
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Telephone | 757-448-5451
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Fax |
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Authorized Official
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Title or Position | FOUNDER/OWNER
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Name | ALEXANDER ABOKA
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Credential | MD
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Telephone | 757-448-5451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | S566493-5
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License Number State | VA
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