Basic Information
| Provider Information | |||||||||
| NPI: | 1497208540 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRECISION CANCER SPECIALISTS MEDICAL GROUP INC | ||||||||
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| Address1: | 940 LUNDY LN | ||||||||
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| City: | LOS ALTOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940245940 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 15400 NATIONAL AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LOS GATOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950322433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4083588400 | ||||||||
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| ProviderEnumerationDate: | 07/25/2016 | ||||||||
| LastUpdateDate: | 07/25/2016 | ||||||||
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| AuthorizedOfficialLastName: | PATEL | ||||||||
| AuthorizedOfficialFirstName: | RAKESH | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6083473405 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 2085R0001X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.