Provider Demographics
NPI:1366584948
Name:VALLEY TUMOR MEDICAL GROUP A MEDICAL CORPORATION
Entity type:Organization
Organization Name:VALLEY TUMOR MEDICAL GROUP A MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:MUKUND
Authorized Official - Middle Name:G
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-948-5928
Mailing Address - Street 1:38660 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE A-380
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-4385
Mailing Address - Country:US
Mailing Address - Phone:661-948-5928
Mailing Address - Fax:661-948-2210
Practice Address - Street 1:38660 MEDICAL CENTER DR
Practice Address - Street 2:SUITE A-380
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-4385
Practice Address - Country:US
Practice Address - Phone:661-948-5928
Practice Address - Fax:661-948-2210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ83686ZMedicaid
CA0844640001Medicare NSC