Healthcare Provider Details

I. General information

NPI: 1821172016
Provider Name (Legal Business Name): CANCERHOPE A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2409 SACRAMENTO STREET
SAN FRANCISCO CA
94115-2225
US

IV. Provider business mailing address

2409 SACRAMENTO STREET
SAN FRANCISCO CA
94115-2225
US

V. Phone/Fax

Practice location:
  • Phone: 415-447-1900
  • Fax: 415-447-1909
Mailing address:
  • Phone: 415-447-1900
  • Fax: 415-447-1909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberA20501
License Number StateCA

VIII. Authorized Official

Name: DR. JORDAN ROCKWOOD WILBUR
Title or Position: PRESIDENT
Credential: MD
Phone: 415-447-1900