1710250709 NPI number — CALIFORNIA CANCER ASSOCIATES FOR RESEARCH AND EXCELLENCE

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 1710250709 NPI number — CALIFORNIA CANCER ASSOCIATES FOR RESEARCH AND EXCELLENCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALIFORNIA CANCER ASSOCIATES FOR RESEARCH AND EXCELLENCE
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:
1710250709
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:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39755 DATE ST STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURRIETA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-733-9191
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/22/2012

Additional Information

Authorized Official

Authorized Official Last Name:
BANERJEE
Authorized Official First Name:
PUSHPENDU
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/ VP
Authorized Official Telephone Number:
559-326-1238

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  A0654578 , 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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