Healthcare Provider Details

I. General information

NPI: 1932852779
Provider Name (Legal Business Name): CALIFORNIA CANCER ASSOCIATES FOR RESEARCH AND EXCELLENCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2022
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 GENESEE AVE STE 560
LA JOLLA CA
92037-1229
US

IV. Provider business mailing address

PO BOX 25100
FRESNO CA
93729-5100
US

V. Phone/Fax

Practice location:
  • Phone: 858-552-1410
  • Fax: 559-326-1230
Mailing address:
  • Phone: 559-326-1238
  • Fax: 559-326-1230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JEDIDIAH M MONSON
Title or Position: PRESIDENT
Credential: MD
Phone: 559-326-1238