| Oxygenwell | |
|
18663 Ventura Blvd Ste 120 Tarzana CA 91356-6806 | |
| (310) 775-3388 | |
| Not Available |
| Full Name | Oxygenwell |
|---|---|
| Speciality | Clinic/Center |
| Location | 18663 Ventura Blvd Ste 120, Tarzana, California |
| Authorized Official Name and Position | Beth Meneley (OWNER) |
| Authorized Official Contact | 3107753388 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Oxygenwell 18663 Ventura Blvd Ste 120 Tarzana CA 91356-6806 Ph: (310) 775-3388 | Oxygenwell 18663 Ventura Blvd Ste 120 Tarzana CA 91356-6806 Ph: (310) 775-3388 |
| NPI Number | 1023716552 |
|---|---|
| Provider Enumeration Date | 02/23/2023 |
| Last Update Date | 12/13/2024 |
| Certification Date | 12/13/2024 |
| Medicare PECOS PAC ID | 6901268200 |
|---|---|
| Medicare Enrollment ID | O20230818000854 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023716552 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Primary |
| Provider Name | Kristen B Davis |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1578643250 PECOS PAC ID: 3375542681 Enrollment ID: I20131217001947 |
| Provider Name | Christine Lori Rongey |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1033403647 PECOS PAC ID: 9739472721 Enrollment ID: I20170928003344 |
| Provider Name | Mithra Moon |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1023587839 PECOS PAC ID: 5092043505 Enrollment ID: I20190821004706 |
| Provider Name | Revital Ahl |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1538769062 PECOS PAC ID: 1153861711 Enrollment ID: I20240910001424 |
| Provider Name | Talia Barkhordari |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1104498757 PECOS PAC ID: 6305370735 Enrollment ID: I20241107003435 |
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