Healthcare Provider Details

I. General information

NPI: 1083132625
Provider Name (Legal Business Name): CENTER FOR CANCER AND BLOOD DISORDERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 S MAIN ST STE 485
ORANGE CA
92868-3833
US

IV. Provider business mailing address

363 S MAIN ST STE 485
ORANGE CA
92868-3833
US

V. Phone/Fax

Practice location:
  • Phone: 714-835-4800
  • Fax: 714-835-1900
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA100358
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: STAVROULA OTIS
Title or Position: DIRECTOR
Credential: MD
Phone: 323-376-8936