Wilshire Oncology Medical Group, Inc.

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

WILSHIRE ONCOLOGY MEDICAL GROUP, INC.

Practice address

210 S Grand Ave
Suite 425
Glendora, CA 91741-4205

Phone

(626) 335-0213

Fax

(626) 335-4041

NPI assigned

Oct 9, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Linda Diane Bosserman, MD

Title

President

Phone

(909) 593-4333

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1191888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257897600000",
    "number": "1487842035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1502 ARROW HWY",
            "city": "LA VERNE",
            "state": "CA",
            "postal_code": "917505318",
            "telephone_number": "909-593-4333",
            "fax_number": "909-593-5588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 S GRAND AVE",
            "address_2": "SUITE 425",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917414205",
            "telephone_number": "626-335-0213",
            "fax_number": "626-335-4041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSHIRE ONCOLOGY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-09",
        "last_updated": "2009-11-11",
        "status": "A",
        "authorized_official_last_name": "BOSSERMAN",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "DIANE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-593-4333",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ77458Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Glendora, CA
• Providers in Glendora, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2009; 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.