Provider Demographics
NPI:1437271798
Name:CANCER CARE CONSULTANTS MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:CANCER CARE CONSULTANTS MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:STEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-828-0061
Mailing Address - Street 1:2428 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2045
Mailing Address - Country:US
Mailing Address - Phone:310-828-0061
Mailing Address - Fax:310-829-2862
Practice Address - Street 1:2428 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2045
Practice Address - Country:US
Practice Address - Phone:310-828-0061
Practice Address - Fax:310-829-2862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP202822085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0058371Medicaid
CAGR0058372Medicaid
CAGR0058373Medicaid
CAGR0058370Medicaid
HW12095DMedicare ID - Type Unspecified
HW12095AMedicare ID - Type Unspecified
CAGR0058372Medicaid
CAGR0058373Medicaid