PACIFIC COAST HEMATOLOGY ONCOLOGY MEDICAL GROUP INC


Address: 9940 Talbert Avenue, Suite 100, Fountain Valley, CA 92708-4019
Phone: 7148450200

PACIFIC COAST HEMATOLOGY ONCOLOGY MEDICAL GROUP INC (NPI# 1265500318) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1265500318
Entity Type Organization
Organization Name PACIFIC COAST HEMATOLOGY ONCOLOGY MEDICAL GROUP INC
Other Organization Name PACIFIC COAST HEMATOLOGY ONCOLOGY MEDICAL GROUP INC
Practice Address 9940 Talbert Avenue
Suite 100
Fountain Valley
CA 92708-4019
Mailing Address 9940 Talbert Ave
Suite 100
Fountain Valley
CA 92708-5153
Practice Telephone 7148450200
Practice Fax Number 7148450239
Mailing Telephone 7148450200
Mailing Fax Number 7148450239
Enumeration Date 2006-11-30
Last Update Date 2018-06-21
Authorized Official Name DR. GLEN R JUSTICE (OWNER PRESIDENT)
Authorized Official Telephone 7148450200
Authorized Official Credential MD
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207RH0003X Internal Medicine
Specialization: Hematology & Oncology
Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
CA BS OF CALIFORNIA ZZZ21205Z 01
CA GR0059571 05

Other Provider/Organization Names

Other Name Type Code
Pacific Coast Hematology Oncology Medical Group Inc Former Legal Business Name - Organization

Office Location

Street Address 9940 TALBERT AVENUE
SUITE 100
City FOUNTAIN VALLEY
State CA
Zip Code 92708-4019

Providers in the same location

NPI Name Taxonomy Address Enumeration
1508012139 Mindy Kaye Bixby Psychiatry & Neurology 9940 Talbert Avenue, Suite 204, Fountain Valley, CA 92708 2008-08-14

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1093293052 Claudia Raquel Santos Physical Therapist 18384 Brookhurst Street, Fountain Valley, CA 92708 2018-08-01
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1144746348 Goose Pharma, LLC Pharmacy 18049 Magnolia Street, Fountain Valley, CA 92708 2017-08-18
1932622347 Mayra Alejandra Guerra Social Worker 18350 Mt Langley St, Suite 200, Fountain Valley, CA 92708 2017-07-18
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Taxonomy Information

Taxonomy Code 207RH0003X
Grouping Allopathic & Osteopathic Physicians
Classification Internal Medicine
Specialization Hematology & Oncology

Taxonomy Definition

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.
Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source]
- Additional Resources: http://www.osteopathic.org/certification

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1396365144 Collin Vu Md, Inc. Internal Medicine 10438 Salinas River Cir, Fountain Valley, CA 92708-6841 2020-04-22
1730240219 Wade Michael Smith Internal Medicine 18111 Brookhurst St Ste 1100, Fountain Valley, CA 92708-6728 2006-12-12
1437269420 Lalita Pandit Md Inc Internal Medicine 11180 Warner Ave Ste 467, Fountain Valley, CA 92708-7505 2006-08-30
1770548596 Khai The Vu Internal Medicine 11190 Warner Ave., Suite 411, Fountain Valley, CA 92708-4019 2006-04-18
1871583575 Ina Planas Internal Medicine 11190 Warner Ave, Suite 401, Fountain Valley, CA 92708-4019 2005-10-24
1689935066 Sarah Z Hassan Internal Medicine 18111 Brookhurst St Ste 6100, Fountain Valley, CA 92708-6728 2012-06-02
1346561206 Marsha G Fink, Md, Inc Internal Medicine 18111 Brookhurst St Ste 6100, Fountain Valley, CA 92708-6728 2010-06-15
1619208279 Jack F Jacoub Md Inc Internal Medicine 18111 Brookhurst St Ste 6100, Fountain Valley, CA 92708-6728 2010-01-21
1417117979 Gurpreet Singh Multani Internal Medicine 11180 Warner Ave, Suite 467, Fountain Valley, CA 92708-7501 2008-06-09
1851582860 Ranjan Sapra Internal Medicine 11190 Warner Ave, Suite 405, Fountain Valley, CA 92708-4019 2007-08-05
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Competitor

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City FOUNTAIN VALLEY
Zip Code 92708

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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