Provider Demographics
NPI:1417087933
Name:CALIFORNIA CANCER SPECIALISTS MEDICAL GROUP
Entity Type:Organization
Organization Name:CALIFORNIA CANCER SPECIALISTS MEDICAL GROUP
Other - Org Name:CITY OF HOPE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-359-8111
Mailing Address - Street 1:PO BOX 5059
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91017
Mailing Address - Country:US
Mailing Address - Phone:626-775-3200
Mailing Address - Fax:626-775-3271
Practice Address - Street 1:50 BELLEFONTAINE
Practice Address - Street 2:SUITE 104
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105
Practice Address - Country:US
Practice Address - Phone:626-396-2900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF HOPE MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-06
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0087670Medicaid
CAGR0087670Medicaid
CAWG62456AAMedicare ID - Type Unspecified