Provider Demographics
NPI:1427050897
Name:CALIFORNIA CANCER MEDICAL CENTER INC
Entity type:Organization
Organization Name:CALIFORNIA CANCER MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PRESANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-593-4333
Mailing Address - Street 1:1502 ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-5318
Mailing Address - Country:US
Mailing Address - Phone:909-593-4333
Mailing Address - Fax:909-593-5588
Practice Address - Street 1:1250 S SUNSET AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3961
Practice Address - Country:US
Practice Address - Phone:626-856-5858
Practice Address - Fax:909-593-5588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A40264Medicare UPIN
W13158Medicare ID - Type Unspecified
CA00G180840Medicare ID - Type Unspecified