Healthcare Provider Details

I. General information

NPI: 1447539374
Provider Name (Legal Business Name): NORTHERN CALIFORNIA CANCER CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1541 FLORIDA AVE SUITE 306
MODESTO CA
95350-4429
US

IV. Provider business mailing address

1541 FLORIDA AVE SUITE 306
MODESTO CA
95350-4429
US

V. Phone/Fax

Practice location:
  • Phone: 209-544-0120
  • Fax: 209-544-0130
Mailing address:
  • Phone: 209-544-0120
  • Fax: 209-544-0130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberG75542
License Number StateCA

VIII. Authorized Official

Name: DR. ROBERT MICHAEL WILLIAMS
Title or Position: CHARIMAN/CEO
Credential: M.D., PH.D.
Phone: 209-544-0120