Provider Demographics
NPI:1134466956
Name:MOUNT DIABLO SOLANO ONCOLOGY GROUP
Entity Type:Organization
Organization Name:MOUNT DIABLO SOLANO ONCOLOGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ODUMAKINDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-674-2108
Mailing Address - Street 1:100 HOSPITAL DR
Mailing Address - Street 2:SUITE 110B
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-2580
Mailing Address - Country:US
Mailing Address - Phone:707-551-3333
Mailing Address - Fax:
Practice Address - Street 1:100 HOSPITAL DR
Practice Address - Street 2:SUITE 110B
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2580
Practice Address - Country:US
Practice Address - Phone:707-551-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty