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General NPI Number Information
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NPI Number | 1578643490
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Entity Type | Organization
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Legal Business Name | CALIFORNIA ONCOLOGY MEDICAL GROUP OF TURLOCK, INC.
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 06/02/2008
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Provider Practice Location Address
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Address Line | 880 E TUOLUMNE RD 103
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City | TURLOCK
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State | CA
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Zip | 95382-1548
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Country | US
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Telephone | 209-669-8300
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Fax | 209-669-9300
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Provider Business Mailing Address
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Address Line | 6121 N THESTA ST 204
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City | FRESNO
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State | CA
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Zip | 93710-8603
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Country | US
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Telephone | 559-438-7390
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Fax | 559-438-7166
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Authorized Official
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Title or Position | DIRECTOR
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Name | MOHAMED ELSAYED ELDALY
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Credential | MD
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Telephone | 209-669-8300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | J13239
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State | CA
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