Healthcare Provider Details

I. General information

NPI: 1659365526
Provider Name (Legal Business Name): HOWARD WAYNE FELLOWS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 07/21/2022
Certification Date: 10/22/2021
Deactivation Date: 03/24/2006
Reactivation Date: 04/13/2006

III. Provider practice location address

11480 BROOKSHIRE AVE STE 309
DOWNEY CA
90241-5025
US

IV. Provider business mailing address

11480 BROOKSHIRE AVE STE 309
DOWNEY CA
90241-5025
US

V. Phone/Fax

Practice location:
  • Phone: 562-869-1201
  • Fax: 562-869-1281
Mailing address:
  • Phone: 562-869-1201
  • Fax: 562-869-1281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number39213
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberG88376
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: