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PACIFIC COAST HEMATOLOGY ONCOLOGY MEDICAL GROUP INC NPI 1265500318


NPI Information

NPI: 1265500318
Provider Name: PACIFIC COAST HEMATOLOGY ONCOLOGY MEDICAL GROUP INC

Former Legal Business Name: PACIFIC COAST HEMATOLOGY ONCOLOGY MEDICAL GROUP INC

Classification: Internal Medicine - 207RH0003X
Entity Type: Organization

Specialization: Hematology & Oncology

Address:
9940 TALBERT AVENUE
SUITE 100
FOUNTAIN VALLEY, CA
ZIP 92708
Phone: (714) 845-0200
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PACIFIC COAST HEMATOLOGY ONCOLOGY MEDICAL GROUP INC is a hematology and oncology internal medicine in Fountain Valley, CA. The provider is an internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. PACIFIC COAST HEMATOLOGY ONCOLOGY MEDICAL GROUP INC NPI is 1265500318. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Former Legal Business Name Is Pacific Coast Hematology Oncology Medical Group Inc.

The provider's business location address is:

9940 TALBERT AVENUE
SUITE 100
FOUNTAIN VALLEY, CA
ZIP 92708-019
Phone: (714) 845-0200
Fax: (714) 845-0239

The provider's authorized official is Glen R Justice .
The authorized official title is Owner President and has the following contact phone number (714) 845-0200.

The enumeration date for this NPI number is 11/30/2006 and was last updated on 6/21/2018.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207RH0003XInternal MedicineHematology & OncologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1=========OTHERCALIFORNIACALOPTIMA
2========= AOTHERCALIFORNIAHEALTH NET SELEC
3GR0059571MEDICAIDCALIFORNIA
4=========OTHERCALIFORNIAUNITED HEALTHCARE
5========= DOTHERCALIFORNIAHEALTH NET SELECT
6========= 0073OTHERCALIFORNIACIGNA
7ZZZ21205ZOTHERCALIFORNIABS OF CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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