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GREATER LOS ANGELES ONCOLOGY MEDICAL CORPORATION NPI 1295746394


NPI Information

NPI: 1295746394
Provider Name: GREATER LOS ANGELES ONCOLOGY MEDICAL CORPORATION

Former Legal Business Name: LOS ANGELES ONCOLOGY MEDICAL GROUP

Classification: Internal Medicine - 207RH0003X
Entity Type: Organization

Specialization: Hematology & Oncology

CLIA Number: 05D2224482

Address:
1626 W TEMPLE ST
LOS ANGELES, CA
ZIP 90026
Phone: (213) 353-0610
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GREATER LOS ANGELES ONCOLOGY MEDICAL CORPORATION is a hematology and oncology internal medicine in Los Angeles, 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. GREATER LOS ANGELES ONCOLOGY MEDICAL CORPORATION NPI is 1295746394. The provider is registered as an organization entity type and is a single specialty group.
The provider Former Legal Business Name Is Los Angeles Oncology Medical Group.

The provider's business location address is:

1626 W TEMPLE ST
LOS ANGELES, CA
ZIP 90026-027
Phone: (213) 353-0610
Fax: (213) 353-4802

The provider's authorized official is Frederick Henry Rundall .
The authorized official title is Ceo and has the following contact phone number (213) 353-0610.

The CLIA number assigned to this NPI record is 05D2224482 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/11/2006 and was last updated on 10/11/2011.


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
1W14720GMEDICARE ID-TYPE UNSPECIFIEDCALIFORNIA
2GR0086530MEDICAIDCALIFORNIA
3DB1410OTHERRAILROAD MEDICARE
4W14720MEDICARE ID-TYPE UNSPECIFIEDCALIFORNIA
5GR0086531MEDICAIDCALIFORNIA
6W14720EMEDICARE ID-TYPE UNSPECIFIEDCALIFORNIA
7CB2861OTHERRAILROAD MEDICARE
8ZZZ08485ZOTHERCALIFORNIABLUE SHIELD
9GR0086534MEDICAIDCALIFORNIA
10W14720DMEDICARE ID-TYPE UNSPECIFIEDCALIFORNIA
11GR0086533MEDICAIDCALIFORNIA

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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