MEDICARE: MICHAEL JAY PAVELOFF M D INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	G78490	CA
2	332B00000X	Durable Medical Equipment & Medical Supplies	4469950001	CA
3	207W00000X	Ophthalmology Physician	G78490	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4557534	OTHER	CA	AETNA

General Provider Information

NPI Number	:	1598989550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL JAY PAVELOFF M D INC

Provider Business Mailing Address
First Line	:	PO BOX 9819
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93389-9819
Country	:	US
Telephone Number	:	805-682-4459
Fax Number	:

Provider Business Practice Location Address
First Line	:	1933 CLIFF DR
Second Line	:	SUITE 29
City	:	SANTA BARBARA
State	:	CA
Zip	:	93109-1520
Country	:	US
Telephone Number	:	805-682-4459
Fax Number	:

Authorized Official
Title or Position	:	BILLING MGR
Name	:	BRANDY SPARKS
Credential	:
Telephone Number	:	661-869-2600

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	02/17/2017

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