Healthcare Provider Details

I. General information

NPI: 1346429362
Provider Name (Legal Business Name): WILSHIRE ONCOLOGY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 BELLEFONTAINE ST SUITE 201
PASADENA CA
91105-3132
US

IV. Provider business mailing address

1502 ARROW HWY
LA VERNE CA
91750-5318
US

V. Phone/Fax

Practice location:
  • Phone: 626-844-8999
  • Fax: 626-844-8995
Mailing address:
  • Phone: 909-593-4333
  • Fax: 909-593-5588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. LINDA DIANA BOSSERMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 909-593-4333