Provider Demographics
NPI:1710250709
Name:CALIFORNIA CANCER ASSOCIATES FOR RESEARCH AND EXCELLENCE
Entity Type:Organization
Organization Name:CALIFORNIA CANCER ASSOCIATES FOR RESEARCH AND EXCELLENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ VP
Authorized Official - Prefix:DR
Authorized Official - First Name:PUSHPENDU
Authorized Official - Middle Name:
Authorized Official - Last Name:BANERJEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-326-1238
Mailing Address - Street 1:PO BOX 25100
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-5100
Mailing Address - Country:US
Mailing Address - Phone:559-326-1238
Mailing Address - Fax:
Practice Address - Street 1:39755 DATE ST STE 103
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563
Practice Address - Country:US
Practice Address - Phone:760-733-9191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0654578207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4157030006Medicare NSC