Basic Information
| Provider Information | |||||||||
| NPI: | 1144433053 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PACIFIC CANCER INSTITUTE LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BOBBY C BAKER MD INC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 BAYVIEW CIR STE 400 | ||||||||
| Address2: | |||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926602984 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9492425592 | ||||||||
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| Practice Location | |||||||||
| Address1: | 227 MAHALANI ST | ||||||||
| Address2: | |||||||||
| City: | WAILUKU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967932526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082422600 | ||||||||
| FaxNumber: | 8082422626 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2007 | ||||||||
| LastUpdateDate: | 01/26/2017 | ||||||||
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| AuthorizedOfficialLastName: | JOHNS | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | EVP, GENERAL COUNSEL-SEC. | ||||||||
| AuthorizedOfficialTelephone: | 8005443215 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QX0203X | Y | Ambulatory Health Care Facilities | Clinic/Center | Oncology, Radiation |
No ID Information.