Healthcare Provider Details

I. General information

NPI: 1578643490
Provider Name (Legal Business Name): CALIFORNIA ONCOLOGY MEDICAL GROUP OF TURLOCK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 E TUOLUMNE RD 103
TURLOCK CA
95382-1548
US

IV. Provider business mailing address

6121 N THESTA ST 204
FRESNO CA
93710-8603
US

V. Phone/Fax

Practice location:
  • Phone: 209-669-8300
  • Fax: 209-669-9300
Mailing address:
  • Phone: 559-438-7390
  • Fax: 559-438-7166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberJ13239
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: MOHAMED ELSAYED ELDALY
Title or Position: DIRECTOR
Credential: MD
Phone: 209-669-8300