1417930744 NPI number — CALIFORNIA CANCER CARE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417930744 NPI number — CALIFORNIA CANCER CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALIFORNIA CANCER CARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417930744
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1350 S ELISEO DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
GREENBRAE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94904-2018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-925-5000
Provider Business Mailing Address Fax Number:
415-925-5050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1350 S ELISEO DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
GREENBRAE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94904-2018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-925-5000
Provider Business Practice Location Address Fax Number:
415-925-5050
Provider Enumeration Date:
11/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BICHKOFF
Authorized Official First Name:
HARVEY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
415-925-5010

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GR0029730 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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