Healthcare Provider Details

I. General information

NPI: 1043208457
Provider Name (Legal Business Name): NORTHERN CALIFORNIA HEMATOLOGY AND ONCOLOGY CONSULTANTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 11/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 DWIGHT WAY
BERKELEY CA
94704-2608
US

IV. Provider business mailing address

2001 DWIGHT WAY
BERKELEY CA
94704-2608
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-6402
  • Fax: 510-848-0801
Mailing address:
  • Phone: 510-204-6402
  • Fax: 510-848-0801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GARY CECCHI
Title or Position: MD/EXECUTIVE DIRECTOR
Credential: M.D.
Phone: 510-204-6402