Pacific Coast Hematology Oncology Medical Group Inc

Primary specialty

Hematology & Oncology PhysicianTaxonomy code 207RH0003X

Legal business name

PACIFIC COAST HEMATOLOGY ONCOLOGY MEDICAL GROUP INC

Practice address

9940 Talbert Avenue
Suite 100
Fountain Valley, CA 92708-4019

Phone

(714) 845-0200

Fax

(714) 845-0239

NPI assigned

Nov 30, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Glen R Justice, MD

Title

Owner President

Phone

(714) 845-0200

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Pacific Coast Hematology Oncology Medical Group Inc Former legal business name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Evangeline A Reyes, M.D.

  • Specialist
  • Corona, CA
  • NPI 1144224908

  Hematology & Oncology

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529539200000",
    "number": "1265500318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9940 TALBERT AVE",
            "address_2": "SUITE 100",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927085153",
            "telephone_number": "714-845-0200",
            "fax_number": "714-845-0239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9940 TALBERT AVENUE",
            "address_2": "SUITE 100",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927084019",
            "telephone_number": "714-845-0200",
            "fax_number": "714-845-0239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC COAST HEMATOLOGY ONCOLOGY MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-30",
        "last_updated": "2018-06-21",
        "status": "A",
        "authorized_official_last_name": "JUSTICE",
        "authorized_official_first_name": "GLEN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "714-845-0200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0059571",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BS OF CALIFORNIA",
            "identifier": "ZZZ21205Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacific Coast Hematology Oncology Medical Group Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Karen Sue Overall, PHYSICAL THERAPIST
• Michael F Ozaki, MD
• P & T Venture Inc (QLT Care Pharmacy)
• Pacific Cardiovascular and Thoracic Associates, Inc.
• Pacific City Recovery
• Pacific Coast Institute Rehab and Physical Therapy Inc.
• Pacific Coast Multi Specialty Surgery, LLC
• Pacific Coast Speech Therapy, Inc (Therapy Lab of OC)
• Pacific Endoscopy and Surgery Center, LLC
• Pacific Endoscopy Center, LLC

• Hematology & Oncology Physician in Fountain Valley, CA
• Providers in Fountain Valley, CA by specialty
• Hematology & Oncology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.