Provider Demographics
NPI:1811927569
Name:COVINA CANCER CARE MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:COVINA CANCER CARE MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:AMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:LAPSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-331-6866
Mailing Address - Street 1:554 E SAN BERNARDINO RD
Mailing Address - Street 2:STE. 105
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1747
Mailing Address - Country:US
Mailing Address - Phone:626-331-6866
Mailing Address - Fax:626-331-6773
Practice Address - Street 1:554 E SAN BERNARDINO RD
Practice Address - Street 2:STE. 105
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1747
Practice Address - Country:US
Practice Address - Phone:626-331-6866
Practice Address - Fax:626-331-6773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50363174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18022Medicare ID - Type Unspecified
CAF66413Medicare UPIN