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General NPI Number Information
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NPI Number | 1376723676
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Entity Type | Organization
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Legal Business Name | WILSHIRE ONCOLOGY MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 11/05/2007
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Last Update Date | 05/07/2008
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Provider Practice Location Address
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Address Line | 935 S SUNSET AVE
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City | WEST COVINA
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State | CA
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Zip | 91790-3408
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Country | US
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Telephone | 626-960-5581
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Fax | 626-960-0881
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Provider Business Mailing Address
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Address Line | 1502 ARROW HWY
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City | LA VERNE
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State | CA
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Zip | 91750-5318
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Country | US
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Telephone | 909-593-4333
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Fax | 909-593-5588
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LINDA DIANA BOSSERMAN
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Credential | MD
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Telephone | 909-593-4333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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