Healthcare Provider Details

I. General information

NPI: 1497868079
Provider Name (Legal Business Name): BRACE LELAND HINTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 12/09/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 E 7TH ST DEPARTMENT OF RADIATION ONCOLOGY
LONG BEACH CA
90822-5201
US

IV. Provider business mailing address

4950 W SUNSET BLVD 2-B
LOS ANGELES CA
90027-5822
US

V. Phone/Fax

Practice location:
  • Phone: 562-826-5605
  • Fax: 562-826-5703
Mailing address:
  • Phone: 323-783-2886
  • Fax: 323-783-5927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberG12572
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: