Provider Demographics
NPI:1417974924
Name:SOUTHBAY ONCOLOGY HEMATOLOGY PARTNERS MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:SOUTHBAY ONCOLOGY HEMATOLOGY PARTNERS MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:RUBENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-376-2300
Mailing Address - Street 1:50 E HAMILTON AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008
Mailing Address - Country:US
Mailing Address - Phone:408-376-2300
Mailing Address - Fax:408-376-2316
Practice Address - Street 1:50 E HAMILTON AVE
Practice Address - Street 2:STE 200
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008
Practice Address - Country:US
Practice Address - Phone:408-376-2300
Practice Address - Fax:408-376-2316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83884207RH0003X
CAG59980207RH0003X
CAG28344207RH0003X
CAC41987207RH0003X
CAG34432207RH0003X
CAA77860207RH0003X
CAA82063207RH0003X
CAA87232207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0064240Medicaid
CACU0119OtherMEDICARE RAILROAD
CAGR0064240Medicaid
CA=========OtherTAX ID