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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