Basic Information
| Provider Information | |||||||||
| NPI: | 1356700678 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PACIFIC OAKS MEDICAL GROUP & SUBSIDIARY | ||||||||
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| OtherOrganizationName: | CONSOLIDATED LABORATORY SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 N ROBERTSON BLVD STE 300 | ||||||||
| Address2: | |||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902112145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106522562 | ||||||||
| FaxNumber: | 3109673698 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 N ROBERTSON BLVD STE 300 | ||||||||
| Address2: | |||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902112145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106522562 | ||||||||
| FaxNumber: | 3109673698 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2016 | ||||||||
| LastUpdateDate: | 07/08/2019 | ||||||||
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| AuthorizedOfficialLastName: | SCARSELLA | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3106522562 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | CLF00010363 | CA | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.