Provider Demographics
NPI:1003283110
Name:THE CANCER TREATMENT CENTER OF ORANGE COUNTY MEDICAL GROUP INC
Entity Type:Organization
Organization Name:THE CANCER TREATMENT CENTER OF ORANGE COUNTY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUPALI
Authorized Official - Middle Name:K
Authorized Official - Last Name:NABAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-517-7242
Mailing Address - Street 1:19582 BEACH BLVD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-2996
Mailing Address - Country:US
Mailing Address - Phone:714-378-4920
Mailing Address - Fax:714-378-4922
Practice Address - Street 1:19582 BEACH BLVD
Practice Address - Street 2:SUITE 270
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2996
Practice Address - Country:US
Practice Address - Phone:714-378-4920
Practice Address - Fax:714-378-4922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98523207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherIRS TIN