Provider Demographics
NPI:1417930744
Name:CALIFORNIA CANCER CARE, INC.
Entity Type:Organization
Organization Name:CALIFORNIA CANCER CARE, INC.
Other - Org Name:MARIN ONCOLOGY ASSOCIATES; HEMATOLOGY/ONCOLOGY OF THE PENINSULA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BICHKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:415-925-5010
Mailing Address - Street 1:1350 S ELISEO DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2018
Mailing Address - Country:US
Mailing Address - Phone:415-925-5000
Mailing Address - Fax:415-925-5050
Practice Address - Street 1:1350 S ELISEO DR
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2018
Practice Address - Country:US
Practice Address - Phone:415-925-5000
Practice Address - Fax:415-925-5050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0029730Medicaid
CAGR0029730Medicaid