Provider Demographics
NPI:1821172016
Name:CANCERHOPE A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:CANCERHOPE A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:ROCKWOOD
Authorized Official - Last Name:WILBUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-447-1900
Mailing Address - Street 1:2409 SACRAMENTO STREET
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2225
Mailing Address - Country:US
Mailing Address - Phone:415-447-1900
Mailing Address - Fax:415-447-1909
Practice Address - Street 1:2409 SACRAMENTO STREET
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2225
Practice Address - Country:US
Practice Address - Phone:415-447-1900
Practice Address - Fax:415-447-1909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA205012080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A205010Medicaid
A20501Medicare ID - Type Unspecified
CA00A205010Medicaid