Basic Information
| Provider Information | |||||||||
| NPI: | 1942572672 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CALIFORNIA CANCER ASSOCIATES FOR RESEARCH AND EXCELLENCE INC | ||||||||
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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: | 9850 GENESEE AVE STE 560 | ||||||||
| Address2: | |||||||||
| City: | LA JOLLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585521410 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2012 | ||||||||
| LastUpdateDate: | 05/10/2022 | ||||||||
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| AuthorizedOfficialLastName: | MONSON | ||||||||
| AuthorizedOfficialFirstName: | JEDIDIAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6152527212 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 05/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332900000X | A69490 | CA | Y | Suppliers | Non-Pharmacy Dispensing Site |
ID Information
| ID | Type | State | Issuer | Description | 5642839 | 01 | CA | NCPDP NUMBER | OTHER |