Healthcare Provider Details

I. General information

NPI: 1710250709
Provider Name (Legal Business Name): CALIFORNIA CANCER ASSOCIATES FOR RESEARCH AND EXCELLENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2012
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39755 DATE ST STE 103
MURRIETA CA
92563
US

IV. Provider business mailing address

PO BOX 25100
FRESNO CA
93729-5100
US

V. Phone/Fax

Practice location:
  • Phone: 760-733-9191
  • Fax:
Mailing address:
  • Phone: 559-326-1238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA0654578
License Number StateCA

VIII. Authorized Official

Name: DR. PUSHPENDU BANERJEE
Title or Position: OWNER/ VP
Credential: M.D
Phone: 559-326-1238