Provider Demographics
NPI:1992999387
Name:OA MEDICAL GROUP INC
Entity type:Organization
Organization Name:OA MEDICAL GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:POLLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-996-8500
Mailing Address - Street 1:1950 SAWTELLE BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:W LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025
Mailing Address - Country:US
Mailing Address - Phone:310-996-8500
Mailing Address - Fax:310-445-8746
Practice Address - Street 1:1950 SAWTELLE BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:W LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025
Practice Address - Country:US
Practice Address - Phone:310-996-8500
Practice Address - Fax:310-445-8746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG29563207X00000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty