Organization
PEDIATRIC HEMATOLOGY ONCOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELLIOTT VICHINSKY M.D. (PARTNER)
(510) 428-3855
Entity
Organization
Contact information
Practice address
747 52ND ST, OAKLAND, CA 94609-1809
(510) 428-3885
Mailing address
5528 PACHECO BLVD, #A, PACHECO, CA 94553-5126
(925) 363-8170
Taxonomy
Speciality
Code
Description
License number
State
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
ZZZ77127Z
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ77127Z
BLUE SHIELD
CA
05
—
ZZZ77127Z
—
CA
Enumeration date
01/03/2007
Last updated
08/23/2013
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