NPIMap

Organization Active NPI

San Joaquin Hematology Oncology a PC

  • Specialist
  • Tracy, CA
National Provider Identifier
1013123496
Registry record updated Jul 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
A70883 Issued in CA
Legal business name
SAN JOAQUIN HEMATOLOGY ONCOLOGY A PC
Practice address
4600 S Tracy Blvd Ste 108
Tracy, CA 95377-8105
Phone
(209) 839-9115
Fax
(209) 833-7262
NPI assigned
May 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Neelesh S Bangalore, MD, PHD
Title
President
Phone
(209) 839-9115

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X A70883 CA Primary

Addresses

Primary practice location

4600 S Tracy Blvd Ste 108
Tracy, CA 95377-8105

Mailing address

PO Box 7667
Stockton, CA 95267-0667
Phone (209) 839-9115

Other identifiers 1

IdentifierTypeStateIssuer
5337360001OtherCADMERC NUMBER

National Provider Directory

National Provider Directory

Locations

4600 S Tracy Blvd
Ste 108
Tracy, CA 95377
Phone (209) 829-9115

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216771200000",
    "number": "1013123496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7667",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952670667",
            "telephone_number": "209-839-9115",
            "fax_number": "209-833-7262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 S TRACY BLVD STE 108",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953778105",
            "telephone_number": "209-839-9115",
            "fax_number": "209-833-7262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JOAQUIN HEMATOLOGY ONCOLOGY A PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-15",
        "last_updated": "2008-07-23",
        "status": "A",
        "authorized_official_last_name": "BANGALORE",
        "authorized_official_first_name": "NEELESH",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-839-9115",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD, PHD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A70883",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC NUMBER",
            "identifier": "5337360001",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tracy, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.