Healthcare Provider Details

I. General information

NPI: 1629840624
Provider Name (Legal Business Name): THE ONCOLOGY INSTITUTE CA, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 S SANTA ANITA ST STE P05
SAN GABRIEL CA
91776-1159
US

IV. Provider business mailing address

18000 STUDEBAKER RD STE 800
CERRITOS CA
90703-2671
US

V. Phone/Fax

Practice location:
  • Phone: 626-652-7433
  • Fax: 424-213-4992
Mailing address:
  • Phone: 562-735-3226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: YALE DAVID PODNOS
Title or Position: PRESIDENT
Credential: MD
Phone: 562-735-3226