Healthcare Provider Details

I. General information

NPI: 1871528471
Provider Name (Legal Business Name): PATRICIA ANNE GANZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL PLAZA #214,365,530,420,120
LOS ANGELES CA
90095-3075
US

IV. Provider business mailing address

5767 W CENTURY BLVD SUITE 200
LOS ANGELES CA
90045-5632
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-1404
  • Fax:
Mailing address:
  • Phone: 310-206-1404
  • Fax: 310-206-3566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberG27102
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: