Healthcare Provider Details

I. General information

NPI: 1265908966
Provider Name (Legal Business Name): CANCER INSTITUTE OF AMERICA MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2018
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 N BEDFORD DR STE 100
BEVERLY HILLS CA
90210-4308
US

IV. Provider business mailing address

416 N BEDFORD DR STE 100
BEVERLY HILLS CA
90210-4308
US

V. Phone/Fax

Practice location:
  • Phone: 310-993-4679
  • Fax: 424-324-3880
Mailing address:
  • Phone: 310-993-4679
  • Fax: 424-324-3880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CRISTIANO BONETI
Title or Position: PRESIDENT
Credential: MD
Phone: 305-951-6543