Provider Demographics
NPI:1851469779
Name:ELITE ONCOLOGY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:ELITE ONCOLOGY MEDICAL GROUP, INC.
Other - Org Name:VALLEY CANCER INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:I
Authorized Official - Last Name:BICHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-398-0013
Mailing Address - Street 1:12099 W WASHINGTON BLVD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-5882
Mailing Address - Country:US
Mailing Address - Phone:310-398-0013
Mailing Address - Fax:310-398-4470
Practice Address - Street 1:12099 W WASHINGTON BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-5882
Practice Address - Country:US
Practice Address - Phone:310-398-0013
Practice Address - Fax:310-398-4470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37798174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20930Medicare UPIN