Provider Demographics
NPI:1578643490
Name:CALIFORNIA ONCOLOGY MEDICAL GROUP OF TURLOCK, INC.
Entity Type:Organization
Organization Name:CALIFORNIA ONCOLOGY MEDICAL GROUP OF TURLOCK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:ELSAYED
Authorized Official - Last Name:ELDALY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-669-8300
Mailing Address - Street 1:6121 N THESTA ST
Mailing Address - Street 2:204
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-8603
Mailing Address - Country:US
Mailing Address - Phone:559-438-7390
Mailing Address - Fax:559-438-7166
Practice Address - Street 1:880 E TUOLUMNE RD
Practice Address - Street 2:103
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-1548
Practice Address - Country:US
Practice Address - Phone:209-669-8300
Practice Address - Fax:209-669-9300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAJ13239207RH0003X
CA207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0103970Medicaid
CAZZZ67013ZOtherBLUE SHIELD
MAJ13239Medicare ID - Type Unspecified
CE9729Medicare PIN
CAZZZ67013ZOtherBLUE SHIELD
CAF43852Medicare UPIN