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Organization
PACIFIC COAST HEMATOLOGY ONCOLOGY MEDICAL GROUP INC
Active
Organization
PACIFIC COAST HEMATOLOGY ONCOLOGY MEDICAL GROUP INC
Active
Other names
Pacific Coast Hematology Oncology Medical Group Inc
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLEN R JUSTICE MD (OWNER PRESIDENT)
(714) 845-0200
Entity
Organization
Contact information
Practice address
9940 TALBERT AVENUE, SUITE 100, FOUNTAIN VALLEY, CA 92708-4019
(714) 845-0200
(714) 845-0239
Mailing address
9940 TALBERT AVE, SUITE 100, FOUNTAIN VALLEY, CA 92708-5153
(714) 845-0200
(714) 845-0239
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0059571
—
CA
01
—
ZZZ21205Z
BS OF CALIFORNIA
CA
Enumeration date
11/30/2006
Last updated
06/21/2018
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