Provider Demographics
NPI:1467464636
Name:HEMATOLOGY-ONCOLOGY MEDICAL GROUP OF FRESNO, INC
Entity Type:Organization
Organization Name:HEMATOLOGY-ONCOLOGY MEDICAL GROUP OF FRESNO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GENTZLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-447-4930
Mailing Address - Street 1:7130 N MILLBROOK AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3347
Mailing Address - Country:US
Mailing Address - Phone:559-447-4949
Mailing Address - Fax:
Practice Address - Street 1:7130 N MILLBROOK AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3347
Practice Address - Country:US
Practice Address - Phone:559-447-4949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ75882ZMedicaid
CAZZZ75882ZMedicare ID - Type Unspecified