Healthcare Provider Details

I. General information

NPI: 1750786299
Provider Name (Legal Business Name): JONSSON COMPREHENSIVE CANCER CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2014
Last Update Date: 10/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 CHARLES YOUNG DR S ROOM A2-125 CHS
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

650 CHARLES YOUNG DR S ROOM A2-125 CHS
LOS ANGELES CA
90095-0001
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-8711
  • Fax: 310-206-3566
Mailing address:
  • Phone: 310-825-8711
  • Fax: 310-206-3566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGC000060
License Number StateCA

VIII. Authorized Official

Name: DR. PATRICIA GANZ
Title or Position: DIRECTOR
Credential: M.D.
Phone: 310-206-1401