Healthcare Provider Details

I. General information

NPI: 1972542959
Provider Name (Legal Business Name): MONTEREY BAY ONCOLOGY A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 HARRIS CT, BLDG T, STE. 201
MONTEREY CA
93940
US

IV. Provider business mailing address

5 HARRIS CT, BLDG T, STE 201
MONTEREY CA
93940
US

V. Phone/Fax

Practice location:
  • Phone: 831-375-4105
  • Fax: 831-372-5722
Mailing address:
  • Phone: 831-375-4105
  • Fax: 831-372-5722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: NICOLE BILLINGSLEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 831-375-4105