Healthcare Provider Details

I. General information

NPI: 1063785897
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: 02/09/2012
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 NORDAHL RD STE 300
SAN MARCOS CA
92069
US

IV. Provider business mailing address

PO BOX 25100
FRESNO CA
93729-5100
US

V. Phone/Fax

Practice location:
  • Phone: 760-747-8935
  • Fax:
Mailing address:
  • Phone: 559-326-1222
  • Fax: 559-326-1230

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: PUSHPENDU BANERJEE
Title or Position: CFO
Credential:
Phone: 858-552-1410