Provider Demographics
NPI:1013208446
Name:EL PORTAL MEDICAL ONCOLOGY INC
Entity Type:Organization
Organization Name:EL PORTAL MEDICAL ONCOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALIREZA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAHMOUDIEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-726-3410
Mailing Address - Street 1:3365 G ST STE 60
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-0995
Mailing Address - Country:US
Mailing Address - Phone:209-726-3410
Mailing Address - Fax:209-726-3371
Practice Address - Street 1:3365 G ST STE 60
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-0995
Practice Address - Country:US
Practice Address - Phone:209-726-3410
Practice Address - Fax:209-726-3371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty