Provider Demographics
NPI:1972675593
Name:CALIFORNIA ONCOLOGY OF THE CENTRAL VALLEY MEDICAL GROUP INC
Entity Type:Organization
Organization Name:CALIFORNIA ONCOLOGY OF THE CENTRAL VALLEY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:R
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-438-7390
Mailing Address - Street 1:6121 N THESTA ST
Mailing Address - Street 2:204
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-8603
Mailing Address - Country:US
Mailing Address - Phone:559-438-7390
Mailing Address - Fax:559-438-7166
Practice Address - Street 1:6121 N THESTA ST
Practice Address - Street 2:STE 204
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8603
Practice Address - Country:US
Practice Address - Phone:559-438-7390
Practice Address - Fax:559-438-7166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAB81677FMedicaid
CACE9729OtherRAILFORD MEDICARE
CAZZZ61936ZOtherBLUE SHIELD
CAGR0079792Medicaid
CAZZZ08841ZOtherBLUE SHIELD
CAGR0079793Medicaid
CAGR0079792Medicaid
CAZZZ19455ZMedicare PIN
CE9729Medicare PIN