Organization
CALIFORNIA CANCER CARE MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MUSSA BANISADRE MD (MEDICAL DOCTOR)
(209) 524-7000
Entity
Organization
Contact information
Practice address
1325 MELROSE AVE, SUITE A, MODESTO, CA 95350-5508
(209) 524-7000
(209) 527-5601
Mailing address
1325 MELROSE AVE, SUITE A, MODESTO, CA 95350-5508
(209) 524-7000
(209) 527-5601
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0057600
—
CA
Enumeration date
05/19/2006
Last updated
02/11/2008
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