Provider Demographics
NPI:1134420201
Name:NORTH VALLEY HEMATOLOGY/ONCOLOGY MEDICAL GROUP
Entity type:Organization
Organization Name:NORTH VALLEY HEMATOLOGY/ONCOLOGY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ENGLE-BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-496-2722
Mailing Address - Street 1:11100-8 SEPULVEDA BLVD
Mailing Address - Street 2:PMB 575
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1101
Mailing Address - Country:US
Mailing Address - Phone:818-496-2721
Mailing Address - Fax:818-496-4126
Practice Address - Street 1:15031 RINALDI ST
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1207
Practice Address - Country:US
Practice Address - Phone:818-365-3099
Practice Address - Fax:818-837-1987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-05
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1134420201Medicaid
CA0163770002Medicare NSC
CAW11618AMedicare PIN