Provider Demographics
NPI:1942572672
Name:CALIFORNIA CANCER ASSOCIATES FOR RESEARCH AND EXCELLENCE INC
Entity Type:Organization
Organization Name:CALIFORNIA CANCER ASSOCIATES FOR RESEARCH AND EXCELLENCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEDIDIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MONSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-252-7212
Mailing Address - Street 1:104 WOODMONT BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2245
Mailing Address - Country:US
Mailing Address - Phone:615-252-7212
Mailing Address - Fax:559-421-7004
Practice Address - Street 1:9850 GENESEE AVE STE 560
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:858-552-1410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69490332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5642839OtherNCPDP NUMBER
CA5642839OtherNCPDP NUMBER