Provider Demographics
NPI:1265908966
Name:CANCER INSTITUTE OF AMERICA MEDICAL CORPORATION
Entity type:Organization
Organization Name:CANCER INSTITUTE OF AMERICA MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRISTIANO
Authorized Official - Middle Name:
Authorized Official - Last Name:BONETI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-951-6543
Mailing Address - Street 1:416 N BEDFORD DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4308
Mailing Address - Country:US
Mailing Address - Phone:310-993-4679
Mailing Address - Fax:424-324-3880
Practice Address - Street 1:416 N BEDFORD DR STE 100
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4308
Practice Address - Country:US
Practice Address - Phone:310-993-4679
Practice Address - Fax:424-324-3880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-19
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1265649487OtherCRISTIANO BONETI