1538413315 NPI number — CALIFORNIA CANCER ASSOCIATES FOR RESEARCH AND EXCELLENCE 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 1538413315 NPI number — CALIFORNIA CANCER ASSOCIATES FOR RESEARCH AND EXCELLENCE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALIFORNIA CANCER ASSOCIATES FOR RESEARCH AND EXCELLENCE 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:
1538413315
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 25100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93729-5100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-326-1238
Provider Business Mailing Address Fax Number:
559-326-1230

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16918 DOVE CANYON RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-309-6595
Provider Business Practice Location Address Fax Number:
858-309-6593
Provider Enumeration Date:
11/01/2012

Additional Information

Authorized Official

Authorized Official Last Name:
BANERJEE
Authorized Official First Name:
PUSHPENDU
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
858-552-1410

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , 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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