MEDICARE: EPEIUS BIOTECHNOLOGIES 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
1	261QX0200X	Oncology Clinic/Center

General Provider Information

NPI Number	:	1477603983
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EPEIUS BIOTECHNOLOGIES CORPORATION

Provider Business Mailing Address
First Line	:	475 HUNTINGTON DR
Second Line	:
City	:	SAN MARINO
State	:	CA
Zip	:	91108-2358
Country	:	US
Telephone Number	:	626-441-6695
Fax Number	:	626-441-6692

Provider Business Practice Location Address
First Line	:	475 HUNTINGTON DR
Second Line	:
City	:	SAN MARINO
State	:	CA
Zip	:	91108-2358
Country	:	US
Telephone Number	:	626-441-6695
Fax Number	:	626-441-6692

Authorized Official
Title or Position	:	VICE PRESIDENT, MEDICAL AFFAIRS
Name	:	ERLINDA MARIA GORDON
Credential	:	M.D.
Telephone Number	:	626-441-6695

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	08/22/2020

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