Provider Demographics
NPI:1588613178
Name:BLOOD & CANCER GENETICS INSTITUTE
Entity type:Organization
Organization Name:BLOOD & CANCER GENETICS INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MURTHY
Authorized Official - Middle Name:V
Authorized Official - Last Name:ANDAVOLU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-770-4034
Mailing Address - Street 1:35400 BOB HOPE DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-1772
Mailing Address - Country:US
Mailing Address - Phone:760-770-4034
Mailing Address - Fax:760-770-1854
Practice Address - Street 1:35400 BOB HOPE DR
Practice Address - Street 2:105
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-1753
Practice Address - Country:US
Practice Address - Phone:760-770-4034
Practice Address - Fax:760-770-1854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAO54407207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty