Provider Demographics
NPI:1386001261
Name:LOS ANGELES HEMATOLOGY ONCOLOGY MEDICAL GROUP
Entity Type:Organization
Organization Name:LOS ANGELES HEMATOLOGY ONCOLOGY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROJECT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:WSIAKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-254-0046
Mailing Address - Street 1:541 W COLORADO ST STE 205
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-3640
Mailing Address - Country:US
Mailing Address - Phone:323-254-0046
Mailing Address - Fax:323-488-9782
Practice Address - Street 1:1505 WILSON TER STE 200
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4073
Practice Address - Country:US
Practice Address - Phone:818-409-0105
Practice Address - Fax:866-810-7504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-22
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56385373336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy