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General NPI Number Information
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NPI Number | 1740648856
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Entity Type | Organization
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Legal Business Name | VALLEY CANCER MEDICAL CENTER INC
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Dates
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Enumeration Date | 02/03/2016
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Last Update Date | 10/11/2023
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Provider Practice Location Address
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Address Line | 1138 NORMAN DR STE 101
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City | MANTECA
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State | CA
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Zip | 95336-5965
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Country | US
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Telephone | 209-823-1609
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Fax | 209-823-1655
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Provider Business Mailing Address
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Address Line | 1138 NORMAN DR STE 101
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City | MANTECA
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State | CA
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Zip | 95336-5965
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Country | US
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Telephone | 209-823-1609
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Fax | 209-823-1655
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Authorized Official
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Title or Position | CEO/MD
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Name | DR. AMARJIT SINGH DHALIWAL
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Credential | MD
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Telephone | 209-823-1609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A49314
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A130901
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | C39275
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A137447
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License Number State | CA
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