Provider Demographics
NPI:1740506781
Name:DEEPAL CEMO MEDICAL SOLUTIONS, LLC
Entity type:Organization
Organization Name:DEEPAL CEMO MEDICAL SOLUTIONS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:ZWECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-933-2300
Mailing Address - Street 1:950 GLENN DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3130
Mailing Address - Country:US
Mailing Address - Phone:916-933-2300
Mailing Address - Fax:916-933-0119
Practice Address - Street 1:945 ROSEVILLE PARKWAY
Practice Address - Street 2:SUITE 150
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-6063
Practice Address - Country:US
Practice Address - Phone:916-788-8444
Practice Address - Fax:916-788-8449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-15
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLR339743261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
05D2005230OtherCLIA WAIVER
CACLR 339743OtherCALIFORNIA CLIA REGISTRATION