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General NPI Number Information
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NPI Number | 1497737183
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Entity Type | Organization
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Legal Business Name | CANCER CENTER ONCOLOGY MEDICAL GROUP, INC-EAST COUNTY
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Dates
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Enumeration Date | 11/17/2005
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Last Update Date | 01/29/2019
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Provider Practice Location Address
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Address Line | 5555 GROSSMONT CENTER DR
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City | LA MESA
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State | CA
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Zip | 91942-3019
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Country | US
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Telephone | 619-644-3030
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Fax | 619-644-3638
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Provider Business Mailing Address
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Address Line | 5555 GROSSMONT CENTER DR
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City | LA MESA
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State | CA
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Zip | 91942-3019
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Country | US
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Telephone | 619-644-3030
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Fax | 619-644-3083
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. DEBBIE MASON
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Credential |
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Telephone | 619-644-3030
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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 | G26407
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License Number State | CA
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