Provider Demographics
NPI:1972542959
Name:MONTEREY BAY ONCOLOGY A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MONTEREY BAY ONCOLOGY A MEDICAL CORPORATION
Other - Org Name:PACIFIC CANCER CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VALERIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WAREHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-375-4105
Mailing Address - Street 1:5 HARRIS CT, BLDG T, STE 201
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940
Mailing Address - Country:US
Mailing Address - Phone:831-375-4105
Mailing Address - Fax:831-372-5722
Practice Address - Street 1:5 HARRIS COURT
Practice Address - Street 2:BUILDING T, 2ND FLOOR # 201
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940
Practice Address - Country:US
Practice Address - Phone:831-375-4105
Practice Address - Fax:831-372-5722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0080140Medicaid
CAZZZ52494ZOtherBCBS
CAGR0080140Medicaid
CAZZZ13460ZMedicare PIN
ZZZ13460ZMedicare PIN