1750394342 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 1750394342 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:
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:
1750394342
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 WOODMONT BLVD STE 500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37205-2245
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-252-7212
Provider Business Mailing Address Fax Number:
559-421-7004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7130 N MILLBROOK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93720-3347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-447-4949
Provider Business Practice Location Address Fax Number:
559-447-4925
Provider Enumeration Date:
08/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MONSON
Authorized Official First Name:
JEDIDIAH
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
615-252-7212

Provider Taxonomy Codes

  • Taxonomy code: 332900000X , with the licence number:  G74904 , 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)





Copyright © 2007-2025 www.npivalidator.com