Healthcare Provider Details

I. General information

NPI: 1487785531
Provider Name (Legal Business Name): CYPRESS WOMENS CANCER TREATMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 MONTEGO STE 100
WALNUT CREEK CA
94598-2990
US

IV. Provider business mailing address

1455 MONTEGO STE 100
WALNUT CREEK CA
94598-2990
US

V. Phone/Fax

Practice location:
  • Phone: 925-627-3440
  • Fax: 925-627-3450
Mailing address:
  • Phone: 925-627-3440
  • Fax: 925-627-3450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberG67092
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG67092
License Number StateCA

VIII. Authorized Official

Name: DR. BABAK EDRAKI
Title or Position: CEO
Credential: M.D.
Phone: 925-627-3440