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General NPI Number Information
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NPI Number | 1902108293
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Entity Type | Organization
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Legal Business Name | WEST VALLEY HEMATOLOGY ONCOLOGY MEDICAL GROUP
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Dates
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Enumeration Date | 11/19/2010
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Last Update Date | 07/22/2013
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Provider Practice Location Address
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Address Line | 18300 ROSCOE BLVD LEAVEY CANCER CENTER
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City | NORTHRIDGE
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State | CA
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Zip | 91325-4105
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Country | US
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Telephone | 818-700-2336
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Fax | 818-700-2337
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Provider Business Mailing Address
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Address Line | PO BOX 11307
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City | SAN BERNARDINO
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State | CA
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Zip | 92423-1307
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Country | US
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Telephone | 888-344-9111
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Fax | 909-335-7130
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | JEROME GARY DAVIDSON
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Credential | MD
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Telephone | 818-700-2336
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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 |
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License Number State |
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