Healthcare Provider Details

I. General information

NPI: 1891139317
Provider Name (Legal Business Name): PCR ONCOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2013
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

584 CAMINO MERCADO
ARROYO GRANDE CA
93420-1816
US

IV. Provider business mailing address

584 CAMINO MERCADO
ARROYO GRANDE CA
93420-1816
US

V. Phone/Fax

Practice location:
  • Phone: 805-474-9143
  • Fax: 805-474-9569
Mailing address:
  • Phone: 805-474-9143
  • Fax: 805-474-9569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberG60994
License Number StateCA

VIII. Authorized Official

Name: MR. DAVID LEIGH PALCHAK
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 805-474-9143