Basic Information
| Provider Information | |||||||||
| NPI: | 1417953878 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIABLO VALLEY ONCOLOGY AND HEMATOLOGY MEDICAL GROUP, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 TAYLOR BLVD | ||||||||
| Address2: | STE 202 | ||||||||
| City: | PLEASANT HILL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945232147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9256775041 | ||||||||
| FaxNumber: | 9256775025 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 TAYLOR BLVD | ||||||||
| Address2: | STE 202 | ||||||||
| City: | PLEASANT HILL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945232147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9256775041 | ||||||||
| FaxNumber: | 9256775025 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2005 | ||||||||
| LastUpdateDate: | 08/16/2012 | ||||||||
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| AuthorizedOfficialLastName: | SIROTT | ||||||||
| AuthorizedOfficialFirstName: | MATHEW | ||||||||
| AuthorizedOfficialMiddleName: | NELSON | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9256775041 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | G73460 | CA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.