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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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