Provider Demographics
NPI:1740648856
Name:VALLEY CANCER MEDICAL CENTER INC
Entity type:Organization
Organization Name:VALLEY CANCER MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:AMARJIT
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:DHALIWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-823-1609
Mailing Address - Street 1:1138 NORMAN DR
Mailing Address - Street 2:STE 101
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-5965
Mailing Address - Country:US
Mailing Address - Phone:209-823-1609
Mailing Address - Fax:209-823-1655
Practice Address - Street 1:1138 NORMAN DR
Practice Address - Street 2:STE 101
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-5965
Practice Address - Country:US
Practice Address - Phone:209-823-1609
Practice Address - Fax:209-823-1655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-03
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49314174400000X
CAA130901174400000X
CAC39275174400000X
CAA137447174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty