Healthcare Provider Details

I. General information

NPI: 1336113489
Provider Name (Legal Business Name): PACIFIC CANCER MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W ROMNEYA DR STE #203
ANAHEIM CA
92801-1830
US

IV. Provider business mailing address

1801 W ROMNEYA DR STE #203
ANAHEIM CA
92801-1830
US

V. Phone/Fax

Practice location:
  • Phone: 714-999-1465
  • Fax: 714-999-1701
Mailing address:
  • Phone: 714-999-1465
  • Fax: 714-999-1701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA45465
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: DR. VEENA CHARU
Title or Position: PRESIDENT/ OWNER
Credential: M.D.
Phone: 714-999-1465