Provider Demographics
NPI:1588653943
Name:PROSTATE ONCOLOGY SPECIALISTS, INC.
Entity Type:Organization
Organization Name:PROSTATE ONCOLOGY SPECIALISTS, INC.
Other - Org Name:MARK SCHOLZ M.D.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT, MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:SCHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-827-7707
Mailing Address - Street 1:4560 ADMIRALTY WAY STE 111
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5424
Mailing Address - Country:US
Mailing Address - Phone:310-827-7707
Mailing Address - Fax:310-574-4002
Practice Address - Street 1:4560 ADMIRALTY WAY STE 111
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5424
Practice Address - Country:US
Practice Address - Phone:310-827-7707
Practice Address - Fax:310-574-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52827174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP24721Medicare UPIN
CAA52359Medicare UPIN
CA5499070001Medicare NSC
CAH43168Medicare UPIN