Basic Information
| Provider Information | |||||||||
| NPI: | 1427361104 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOUNT DIABLO SOLANO ONCOLOGY GROUP MEDICAL ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2571 PARK AVE | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945201901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9256742100 | ||||||||
| FaxNumber: | 9256895135 | ||||||||
| Practice Location | |||||||||
| Address1: | 2571 PARK AVE | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945201901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9256742100 | ||||||||
| FaxNumber: | 9256895135 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2010 | ||||||||
| LastUpdateDate: | 06/09/2011 | ||||||||
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| AuthorizedOfficialLastName: | ODUMAKINDE | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9256742100 | ||||||||
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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 | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.