1417953878 NPI number — DIABLO VALLEY ONCOLOGY AND HEMATOLOGY MEDICAL GROUP, 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 1417953878 NPI number — DIABLO VALLEY ONCOLOGY AND HEMATOLOGY MEDICAL GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIABLO VALLEY ONCOLOGY AND HEMATOLOGY MEDICAL GROUP, 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:
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:
1417953878
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 TAYLOR BLVD
Provider Second Line Business Mailing Address:
STE 202
Provider Business Mailing Address City Name:
PLEASANT HILL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94523-2147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-677-5041
Provider Business Mailing Address Fax Number:
925-677-5025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 TAYLOR BLVD
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
PLEASANT HILL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94523-2147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-677-5041
Provider Business Practice Location Address Fax Number:
925-677-5025
Provider Enumeration Date:
06/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SIROTT
Authorized Official First Name:
MATHEW
Authorized Official Middle Name:
NELSON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
925-677-5041

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  G73460 , 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)





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