| Oceanside Medical Group, A Medical Corporation | |
|
701 Santa Monica Blvd Suite 230 Santa Monica CA 90401-2623 | |
| (310) 993-4103 | |
| (805) 494-8385 |
| Full Name | Oceanside Medical Group, A Medical Corporation |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 701 Santa Monica Blvd, Santa Monica, California |
| Authorized Official Name and Position | Gadson J Johnson (PRESIDENT) |
| Authorized Official Contact | 3109934103 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Oceanside Medical Group, A Medical Corporation 701 Santa Monica Blvd Suite 230 Santa Monica CA 90401-2623 Ph: (310) 993-4103 | Oceanside Medical Group, A Medical Corporation 701 Santa Monica Blvd Suite 230 Santa Monica CA 90401-2623 Ph: (310) 993-4103 |
| NPI Number | 1861770513 |
|---|---|
| Provider Enumeration Date | 07/29/2011 |
| Last Update Date | 07/29/2011 |
| Medicare PECOS PAC ID | 9335311042 |
|---|---|
| Medicare Enrollment ID | O20110930000204 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861770513 | NPI | - | NPPES |
| FNP41555 | Other | CA | FNP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 2084P0805X | Psychiatry & Neurology - Geriatric Psychiatry | (* (Not Available)) | Secondary |
| Provider Name | John A Rabin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1124185442 PECOS PAC ID: 9830087600 Enrollment ID: I20040304001230 |
| Provider Name | Jill Hitselberger |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1922252873 PECOS PAC ID: 9638073778 Enrollment ID: I20041116000609 |
| Provider Name | Anna I Lau |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1942240882 PECOS PAC ID: 2961455019 Enrollment ID: I20050301000353 |
| Provider Name | Behnam Partovi |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1306851076 PECOS PAC ID: 9335146943 Enrollment ID: I20061024000430 |
| Provider Name | Gadson John Johnson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578767232 PECOS PAC ID: 3577631852 Enrollment ID: I20090605000608 |
| Provider Name | A. Carol Abkarian |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1255525671 PECOS PAC ID: 3274662838 Enrollment ID: I20100520000562 |
| Provider Name | Osamamwode S Ogbeiwi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609047166 PECOS PAC ID: 5496919920 Enrollment ID: I20120614000107 |
| Provider Name | Ekerette J Essien |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1396706438 PECOS PAC ID: 6507873379 Enrollment ID: I20140102000817 |
| Provider Name | Mario Alberto Pacheco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568887669 PECOS PAC ID: 9133347388 Enrollment ID: I20140829000607 |
| Provider Name | Adaobi J Ozoh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346373172 PECOS PAC ID: 4587986344 Enrollment ID: I20141205000022 |
| Provider Name | Robert Wayne Baker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689225427 PECOS PAC ID: 9931534906 Enrollment ID: I20200121002493 |
| Provider Name | Hugo M Gozos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114539939 PECOS PAC ID: 2264859875 Enrollment ID: I20200827002600 |
| Provider Name | Alice Wambui |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790269025 PECOS PAC ID: 9830517135 Enrollment ID: I20200918001209 |
| Provider Name | Jessica Erene B Paz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326600289 PECOS PAC ID: 2567874258 Enrollment ID: I20201222002673 |
| Provider Name | Phong Kieu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295495737 PECOS PAC ID: 9931593696 Enrollment ID: I20220223002748 |
| Provider Name | Susanna Ovsepyan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154029874 PECOS PAC ID: 8527420793 Enrollment ID: I20230821001037 |
| Provider Name | Mariya Libman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992488068 PECOS PAC ID: 5395194179 Enrollment ID: I20231211002272 |
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