| Ocean Life Medical Group Inc | |
|
18069 W Terra Verde Place Santa Clarita CA 91387-1830 | |
| (661) 360-7523 | |
| (661) 424-7900 |
| Full Name | Ocean Life Medical Group Inc |
|---|---|
| Speciality | General Practice |
| Location | 18069 W Terra Verde Place, Santa Clarita, California |
| Authorized Official Name and Position | Luis M Origel (PRESIDENT/CEO) |
| Authorized Official Contact | 6612891154 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ocean Life Medical Group Inc 18069 W Terra Verde Place Santa Clarita CA 91387-1830 Ph: (661) 360-7523 | Ocean Life Medical Group Inc 18069 W Terra Verde Place Santa Clarita CA 91387-1830 Ph: (661) 360-7523 |
| NPI Number | 1720645104 |
|---|---|
| Provider Enumeration Date | 05/21/2019 |
| Last Update Date | 05/21/2019 |
| Medicare PECOS PAC ID | 6608208533 |
|---|---|
| Medicare Enrollment ID | O20191114003408 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720645104 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Vincent J Bennett |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1982650776 PECOS PAC ID: 5496644478 Enrollment ID: I20040315001384 |
| Provider Name | Luis M Origel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447672696 PECOS PAC ID: 2961704283 Enrollment ID: I20160104002067 |
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