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General NPI Number Information
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NPI Number | 1962634972
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Entity Type | Organization
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Legal Business Name | CENTER FOR INTEGRATIVE CANCER TREATMENT, INC.
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Dates
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Enumeration Date | 08/10/2009
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Last Update Date | 12/16/2009
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Provider Practice Location Address
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Address Line | 6 HUGHES SUITE 120
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City | IRVINE
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State | CA
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Zip | 92618-2059
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Country | US
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Telephone | 949-680-1881
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Fax | 949-581-4090
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Provider Business Mailing Address
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Address Line | 6 HUGHES SUITE 120
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City | IRVINE
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State | CA
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Zip | 92618-2059
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Country | US
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Telephone | 949-680-1881
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Fax | 949-581-4090
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. WARREN H. FONG
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Credential | M.D.
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Telephone | 949-574-1610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0200X
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Taxonomy Name | Oncology Clinic/Center
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License Number |
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License Number State |
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