Healthcare Provider Details

I. General information

NPI: 1003283110
Provider Name (Legal Business Name): THE CANCER TREATMENT CENTER OF ORANGE COUNTY MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 08/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19582 BEACH BLVD SUITE 270
HUNTINGTON BEACH CA
92648-2996
US

IV. Provider business mailing address

19582 BEACH BLVD SUITE 270
HUNTINGTON BEACH CA
92648-2996
US

V. Phone/Fax

Practice location:
  • Phone: 714-378-4920
  • Fax: 714-378-4922
Mailing address:
  • Phone: 714-378-4920
  • Fax: 714-378-4922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA98523
License Number StateCA

VIII. Authorized Official

Name: RUPALI K NABAR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 415-517-7242