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General NPI Number Information
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NPI Number | 1851794226
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Entity Type | Organization
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Legal Business Name | OSF MEDICAL GROUP OF CALIFORNIA, INC.
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Dates
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Enumeration Date | 09/30/2014
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Last Update Date | 09/30/2014
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Provider Practice Location Address
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Address Line | 640 S B ST
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City | OXNARD
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State | CA
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Zip | 93030-7142
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Country | US
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Telephone | 805-485-7042
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Fax | 805-485-0716
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Provider Business Mailing Address
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Address Line | PO BOX 3559
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93403-3559
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Country | US
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Telephone | 805-786-4879
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Fax | 805-597-8354
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | ALAN MOELLEKEN
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Credential | MD
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Telephone | 805-563-3307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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