NPIMap

Organization Active NPI

St Jude Hospital Yorba Linda

  • Medical Oncology Physician
  • Santa Rosa, CA
National Provider Identifier
1043608805
Registry record updated Jun 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Oncology PhysicianTaxonomy code 207RX0202X
Legal business name
ST JUDE HOSPITAL YORBA LINDA
Doing business as
St Joseph Heritage Healthcare
Practice address
3555 Round Barn Cir
Santa Rosa, CA 95403-1757
Phone
(707) 528-1050
Fax
(707) 525-3874
NPI assigned
Jan 2, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2015

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

Authorized official

Name
Bob Just
Title
Chief Operating Officer
Phone
(707) 303-8355

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RX0202X Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

3555 Round Barn Cir
Santa Rosa, CA 95403-1757

Mailing address

279 Imperial Hwy
Suite 730
Fullerton, CA 92835-1041
Phone (714) 449-4841

Other identifiers 1

IdentifierTypeStateIssuer
6852510004OtherCANSC

Other names 1

  • St Joseph Heritage Healthcare Doing business as

National Provider Directory

National Provider Directory

Member of 3

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1420156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433980800000",
    "number": "1043608805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "279 IMPERIAL HWY",
            "address_2": "SUITE 730",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928351041",
            "telephone_number": "714-449-4841",
            "fax_number": "714-449-4956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3555 ROUND BARN CIR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954031757",
            "telephone_number": "707-528-1050",
            "fax_number": "707-525-3874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JUDE HOSPITAL YORBA LINDA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-02",
        "last_updated": "2015-06-11",
        "status": "A",
        "authorized_official_last_name": "JUST",
        "authorized_official_first_name": "BOB",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "707-303-8355"
    },
    "taxonomies": [
        {
            "code": "207RX0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Medical Oncology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NSC",
            "identifier": "6852510004",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Joseph Heritage Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2015; 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.