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General NPI Number Information
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NPI Number | 1386001261
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Entity Type | Organization
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Legal Business Name | LOS ANGELES HEMATOLOGY ONCOLOGY MEDICAL GROUP
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Dates
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Enumeration Date | 01/22/2016
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Last Update Date | 03/02/2021
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Provider Practice Location Address
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Address Line | 1505 WILSON TER STE 200
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City | GLENDALE
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State | CA
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Zip | 91206-4073
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Country | US
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Telephone | 818-409-0105
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Fax | 866-810-7504
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Provider Business Mailing Address
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Address Line | 541 W COLORADO ST STE 205
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City | GLENDALE
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State | CA
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Zip | 91204-3640
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Country | US
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Telephone | 323-254-0046
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Fax | 323-488-9782
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Authorized Official
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Title or Position | PROJECT MANAGER
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Name | MARLA LOU WSIAKI
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Credential |
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Telephone | 323-254-0046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 5638537
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License Number State | CA
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