Provider Demographics
NPI:1104201292
Name:HEMATOLOGY ONCOLOGY MEDICAL GROUP
Entity Type:Organization
Organization Name:HEMATOLOGY ONCOLOGY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SITE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BELTRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-981-3818
Mailing Address - Street 1:16133 VENTURA BLVD
Mailing Address - Street 2:SUITE 470
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2403
Mailing Address - Country:US
Mailing Address - Phone:818-981-3818
Mailing Address - Fax:818-784-3106
Practice Address - Street 1:16133 VENTURA BLVD
Practice Address - Street 2:SUITE 470
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2403
Practice Address - Country:US
Practice Address - Phone:818-981-3818
Practice Address - Fax:818-784-3106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70618207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A786180Medicaid
CA00A786180Medicaid