Provider Demographics
NPI:1154282127
Name:CANCER AND BLOOD SPECIALTY CLINIC
Entity type:Organization
Organization Name:CANCER AND BLOOD SPECIALTY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/COO
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:T
Authorized Official - Last Name:KE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-394-0993
Mailing Address - Street 1:PO LOCKBOX 743752
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-3752
Mailing Address - Country:US
Mailing Address - Phone:562-725-4368
Mailing Address - Fax:562-725-4369
Practice Address - Street 1:3106 PONTE MORINO DR STE B
Practice Address - Street 2:
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-8281
Practice Address - Country:US
Practice Address - Phone:530-631-1310
Practice Address - Fax:530-631-1311
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CANCER AND BLOOD SPECIALTY CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-11-19
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site