Healthcare Provider Details

I. General information

NPI: 1568909356
Provider Name (Legal Business Name): NEVADA PEDIATRIC HEMATOLOGY ONCOLOGY (HASTINGS) PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 RENO CORPORATE DR
RENO NV
89511-2381
US

IV. Provider business mailing address

5528 PACHECO BLVD BLDG A
PACHECO CA
94553-5157
US

V. Phone/Fax

Practice location:
  • Phone: 775-683-9010
  • Fax:
Mailing address:
  • Phone: 925-363-8170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CAROLINE HASTINGS
Title or Position: PARTNER
Credential:
Phone: 510-428-3855