Healthcare Provider Details

I. General information

NPI: 1467464636
Provider Name (Legal Business Name): HEMATOLOGY-ONCOLOGY MEDICAL GROUP OF FRESNO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 02/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7130 N MILLBROOK AVE SUITE 100
FRESNO CA
93720-3347
US

IV. Provider business mailing address

7130 N MILLBROOK AVE SUITE 100
FRESNO CA
93720-3347
US

V. Phone/Fax

Practice location:
  • Phone: 559-447-4949
  • Fax:
Mailing address:
  • Phone: 559-447-4949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHERYL LYNN GENTZLER
Title or Position: ADMINISTRATOR
Credential:
Phone: 559-447-4930