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General NPI Number Information
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NPI Number | 1447077987
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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 | 09/25/2024
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 1801 W ROMNEYA DR STE 203
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City | ANAHEIM
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State | CA
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Zip | 92801-1824
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Country | US
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Telephone | 714-999-1465
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Fax |
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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 |
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Authorized Official
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Title or Position | CEO
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Name | BORIS BAGDASARIAN
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Credential |
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Telephone | 818-409-0105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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