Healthcare Provider Details

I. General information

NPI: 1750543740
Provider Name (Legal Business Name): COAST HEM ONCOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E 28TH ST SUITE 418
LONG BEACH CA
90806-2759
US

IV. Provider business mailing address

701 E 28TH ST SUITE 418
LONG BEACH CA
90806-2759
US

V. Phone/Fax

Practice location:
  • Phone: 562-997-1239
  • Fax:
Mailing address:
  • Phone: 562-997-1239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH FARACE
Title or Position: BILLING MANAGER
Credential:
Phone: 714-516-4295