Provider Demographics
NPI:1104829860
Name:CALIFORNIA ENDOCURIETHERAPY MEDICAL CORPORATION
Entity type:Organization
Organization Name:CALIFORNIA ENDOCURIETHERAPY MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:DEMANES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-986-0690
Mailing Address - Street 1:3012 SUMMIT ST
Mailing Address - Street 2:STE 2675
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3480
Mailing Address - Country:US
Mailing Address - Phone:510-986-0690
Mailing Address - Fax:510-986-0159
Practice Address - Street 1:3012 SUMMIT ST
Practice Address - Street 2:STE 2675
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3480
Practice Address - Country:US
Practice Address - Phone:510-986-0690
Practice Address - Fax:510-986-0159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG29678174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG29678OtherDJ DEMANES ST.. LICENSE#
CAA43655OtherDR.V. UHL STATE LICENSE#
CAG17225OtherDR.D.HILL ST. LICENSE
CAA43655OtherDR.V. UHL STATE LICENSE#
CABU1032729OtherDR. V. UHL DEA#
CAG17225OtherDR.D.HILL ST. LICENSE
CAMMM00183MMedicare ID - Type UnspecifiedCET MEDICARE GROUP #
CA00G172251Medicare ID - Type UnspecifiedDR.D.HILL PPIN MEDICARE #
CABH8882880OtherDR.D.HILL DEA#
CABU1032729OtherDR. V. UHL DEA#
CAA44112Medicare UPIN
CAG17225OtherDR.D.HILL ST. LICENSE
CAG29678OtherDJ DEMANES ST.. LICENSE#