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).
| 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 |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | BS OF CALIFORNIA | ZZZ21205Z | 01 |
| CA | GR0059571 | 05 |
| Other Name | Type Code |
|---|---|
| Pacific Coast Hematology Oncology Medical Group Inc | Former Legal Business Name - Organization |
| Street Address |
9940 TALBERT AVENUE SUITE 100 |
| City | FOUNTAIN VALLEY |
| State | CA |
| Zip Code | 92708-4019 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508012139 | Mindy Kaye Bixby | Psychiatry & Neurology | 9940 Talbert Avenue, Suite 204, Fountain Valley, CA 92708 | 2008-08-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932716222 | Changing Directions Psychological Corporation | Psychologist | 17280 Newhope Street, Suite 4, Fountain Valley, CA 92708 | 2020-09-30 |
| 1124632757 | Neck & Back Pain Specialists, A Balta Chiropractic Corporation | Chiropractor | 10231 Slater Ave. #113, Fountain Valley, CA 92708 | 2020-09-01 |
| 1295205425 | Alexander Nee Dds Inc | Dentist | 337 S Rancho Santa Fe Rd, San Marcos, CA 92708 | 2018-11-30 |
| 1093293052 | Claudia Raquel Santos | Physical Therapist | 18384 Brookhurst Street, Fountain Valley, CA 92708 | 2018-08-01 |
| 1659864338 | Orange County Respiratory Physicians Corp | Internal Medicine | 18111 Brookhurst St Ste 4600, Fountain Valley, CA 92708 | 2018-06-07 |
| 1992297881 | Ereny Abdelmalak Metry | Pharmacist | 9064 Daffodil Ave, Fountain Valley, CA 92708 | 2018-06-06 |
| 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 |
| 1942722129 | Graph Surgery Inc | Plastic Surgery | 10760 Warner Ave, Ste 201, Fountain Valley, CA 92708 | 2017-07-10 |
| 1871022277 | Cathy A Castagna-petersen | Counselor | 10529 Slater Avenue, Fountain Valley, CA 92708 | 2017-06-08 |
| Find all providers in zip 92708 | ||||
| Taxonomy Code | 207RH0003X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Hematology & Oncology |
| 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 |
| 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 |
| Find all providers in FOUNTAIN VALLEY | ||||
| City | FOUNTAIN VALLEY |
| Zip Code | 92708 |
Please comment or provide details below to improve the information on PACIFIC COAST HEMATOLOGY ONCOLOGY MEDICAL GROUP INC.
| 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.