Provider Demographics
NPI:1205007408
Name:MONTEREY BAY ONCOLOGY
Entity Type:Organization
Organization Name:MONTEREY BAY ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:CMC
Authorized Official - Phone:831-642-4060
Mailing Address - Street 1:5 HARRIS CT BLDG T
Mailing Address - Street 2:2ND FLOOR SUITE 201
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5750
Mailing Address - Country:US
Mailing Address - Phone:831-375-4105
Mailing Address - Fax:831-372-5722
Practice Address - Street 1:5 HARRIS CT BLDG T2ND
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5750
Practice Address - Country:US
Practice Address - Phone:831-375-4105
Practice Address - Fax:831-372-5722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ71527ZOtherBLUE SHIELD
CA5640924OtherNCPDP
CA05D0590281OtherCLIA
CAGR0076250Medicaid
CA05D0691381OtherCLIA
ZZZ71527ZOtherBLUE SHIELD
CAGR0076250Medicaid
CA00G602521Medicare PIN
CA5640924OtherNCPDP
CA00C327490Medicare PIN