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NPI Code Detail

MEDICARE: PREMIERE ONCOLOGY, A MEDICAL CORPORATION

MEDICARE: PREMIERE ONCOLOGY, A MEDICAL CORPORATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistA49741CA
2174400000XSpecialistA52720CA
3174400000XSpecialistG73680CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1A49741OTHERCAMEDICAL LICENSE - ROSEN
2A52720OTHERCAMEDICAL LICENSE - GARCIA
3G73680OTHERCAMEDICAL LICENSE - CHAP

General Provider Information

NPI Number : 1235186859
Entity Type Code : Organization
Provider Name (Legal Business Name) : PREMIERE ONCOLOGY, A MEDICAL CORPORATION
Provider Business Mailing Address
First Line : 2020 SANTA MONICA BLVD STE 600
Second Line :
City : SANTA MONICA
State : CA
Zip : 90404-2131
Country : US
Telephone Number : 310-633-8400
Fax Number : 310-633-8419
Provider Business Practice Location Address
First Line : 2020 SANTA MONICA BLVD STE 600
Second Line :
City : SANTA MONICA
State : CA
Zip : 90404-2131
Country : US
Telephone Number : 310-633-8400
Fax Number : 310-633-8419
Authorized Official
Title or Position : PREISDENT AND CEO
Name : DR. LEE S ROSEN
Credential : M.D.
Telephone Number : 310-633-8400
Provider Enumeration Date : 05/28/2006
Last Update Date : 08/28/2009

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