1154282127 NPI number — CANCER AND BLOOD SPECIALTY CLINIC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154282127 NPI number — CANCER AND BLOOD SPECIALTY CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CANCER AND BLOOD SPECIALTY CLINIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154282127
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO LOCKBOX 743752
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90074-3752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-725-4368
Provider Business Mailing Address Fax Number:
562-725-4369

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3106 PONTE MORINO DR STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMERON PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95682-8281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-631-1310
Provider Business Practice Location Address Fax Number:
530-631-1311
Provider Enumeration Date:
11/19/2025

Additional Information

Authorized Official

Authorized Official Last Name:
KE
Authorized Official First Name:
ANN
Authorized Official Middle Name:
T
Authorized Official Title or Position:
CFO/COO
Authorized Official Telephone Number:
714-394-0993

Provider Taxonomy Codes

  • Taxonomy code: 332900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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