Provider Demographics
NPI:1497857445
Name:NAGOURNEY CANCER INSTITUTE A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:NAGOURNEY CANCER INSTITUTE A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFRANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-989-6455
Mailing Address - Street 1:750 E 29TH STREET
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806
Mailing Address - Country:US
Mailing Address - Phone:562-989-6455
Mailing Address - Fax:562-989-6454
Practice Address - Street 1:750 E 29TH STREET
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806
Practice Address - Country:US
Practice Address - Phone:562-989-6455
Practice Address - Fax:562-989-6454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W14996Medicare ID - Type Unspecified
A49290Medicare UPIN