Provider Demographics
NPI:1952444663
Name:ONCOLOGY INSTITUTE MEDICAL GROUP
Entity Type:Organization
Organization Name:ONCOLOGY INSTITUTE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GIULIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-202-6204
Mailing Address - Street 1:PO BOX 512835
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-0835
Mailing Address - Country:US
Mailing Address - Phone:310-202-6204
Mailing Address - Fax:310-202-0831
Practice Address - Street 1:1328 22ND ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2032
Practice Address - Country:US
Practice Address - Phone:310-202-6204
Practice Address - Fax:310-202-0831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW11692Medicare ID - Type UnspecifiedMEDICARE GROUP #