Provider Demographics
NPI:1801964317
Name:LOS ALAMITOS HEMATOLOGY/ONCOLOGY MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:LOS ALAMITOS HEMATOLOGY/ONCOLOGY MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-598-9745
Mailing Address - Street 1:3801 KATELLA AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3338
Mailing Address - Country:US
Mailing Address - Phone:562-598-9745
Mailing Address - Fax:562-598-0355
Practice Address - Street 1:3801 KATELLA AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720
Practice Address - Country:US
Practice Address - Phone:562-598-9745
Practice Address - Fax:562-598-0355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2024-09-30
Deactivation Date:2018-07-26
Deactivation Code:
Reactivation Date:2018-07-31
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW3572Medicare UPIN
CA0195860001Medicare NSC