MEDICARE: NEVADA PEDIATRIC HEMATOLOGY ONCOLOGY (HASTINGS) PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0207X	Pediatric Hematology & Oncology Physician

General Provider Information

NPI Number	:	1568909356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEVADA PEDIATRIC HEMATOLOGY ONCOLOGY (HASTINGS) PC

Provider Business Mailing Address
First Line	:	5528 PACHECO BLVD BLDG A
Second Line	:
City	:	PACHECO
State	:	CA
Zip	:	94553-5157
Country	:	US
Telephone Number	:	925-363-8170
Fax Number	:

Provider Business Practice Location Address
First Line	:	5301 RENO CORPORATE DR
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89511-2381
Country	:	US
Telephone Number	:	775-683-9010
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	CAROLINE HASTINGS
Credential	:
Telephone Number	:	510-428-3855

Provider Enumeration Date	:	01/31/2017
Last Update Date	:	01/31/2017

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