1669576211 NPI number — HEMATOLOGY ONCOLOGY CONSULTANTS

Table of content: (NPI 1669576211)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669576211 NPI number — HEMATOLOGY ONCOLOGY CONSULTANTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEMATOLOGY ONCOLOGY CONSULTANTS
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:
1669576211
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6850 SEPULVEDA BLVD 211
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VAN NUYS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91405-4451
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-994-0101
Provider Business Mailing Address Fax Number:
818-902-5566

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23101 SHERMAN PL
Provider Second Line Business Practice Location Address:
410
Provider Business Practice Location Address City Name:
WEST HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91307-2003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-587-9380
Provider Business Practice Location Address Fax Number:
818-346-7025
Provider Enumeration Date:
09/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GOLDSTEIN
Authorized Official First Name:
MARK
Authorized Official Middle Name:
LEONARD
Authorized Official Title or Position:
DOCTOR PARTNER
Authorized Official Telephone Number:
818-994-0101

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GR0044501 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ47615Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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