Healthcare Provider Details

I. General information

NPI: 1487842035
Provider Name (Legal Business Name): WILSHIRE ONCOLOGY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 11/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S GRAND AVE SUITE 425
GLENDORA CA
91741-4205
US

IV. Provider business mailing address

1502 ARROW HWY
LA VERNE CA
91750-5318
US

V. Phone/Fax

Practice location:
  • Phone: 626-335-0213
  • Fax: 626-335-4041
Mailing address:
  • Phone: 909-593-4333
  • Fax: 909-593-5588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. LINDA DIANE BOSSERMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 909-593-4333