Basic Information
| Provider Information | |||||||||
| NPI: | 1750394342 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CALIFORNIA CANCER ASSOCIATES FOR RESEARCH AND EXCELLENCE, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CCARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 104 WOODMONT BLVD STE 500 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372052245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152527212 | ||||||||
| FaxNumber: | 5594217004 | ||||||||
| Practice Location | |||||||||
| Address1: | 7130 N MILLBROOK AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937203347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594474949 | ||||||||
| FaxNumber: | 5594474925 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2006 | ||||||||
| LastUpdateDate: | 05/10/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| AuthorizedOfficialLastName: | MONSON | ||||||||
| AuthorizedOfficialFirstName: | JEDIDIAH | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6152527212 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 01/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332900000X | G74904 | CA | Y | Suppliers | Non-Pharmacy Dispensing Site |
No ID Information.