Provider Demographics
NPI:1821405192
Name:ALTABATES COMPREHENSIVE CANCER CENTER
Entity Type:Organization
Organization Name:ALTABATES COMPREHENSIVE CANCER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE CASE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:510-204-1591
Mailing Address - Street 1:901 JEFFERSON ST
Mailing Address - Street 2:APT #301
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-3552
Mailing Address - Country:US
Mailing Address - Phone:415-786-9469
Mailing Address - Fax:
Practice Address - Street 1:2001 DWIGHT WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2608
Practice Address - Country:US
Practice Address - Phone:510-204-1591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA788303261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology