Provider Demographics
NPI:1629046925
Name:MEDICAL ONCOLOGY ASSOCIATES OF SAN DIEGO A MEDICAL GROUP INC
Entity type:Organization
Organization Name:MEDICAL ONCOLOGY ASSOCIATES OF SAN DIEGO A MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIALIST/CHIEF PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-637-7888
Mailing Address - Street 1:3075 HEALTH CENTER DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2773
Mailing Address - Country:US
Mailing Address - Phone:858-637-7888
Mailing Address - Fax:858-637-7887
Practice Address - Street 1:3075 HEALTH CENTER DR
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2773
Practice Address - Country:US
Practice Address - Phone:858-637-7888
Practice Address - Fax:858-637-7887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematologyGroup - Multi-Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA800298078Medicaid
CAGR0060290Medicaid
CA0666140002Medicare NSC