Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | A69490 | CA |
NPI | 1164497855 |
---|---|
Provider Name | Dr. Pushpendu Banerjee |
First Address | Fresno, CA 93729-5100 |
Second Address | La Jolla, CA 92037-1229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2006 |
Last Update Date | 23/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A694900 | (05) | CA |
A69490 | MEDICAL LICENSE (01) | CA |
FX071Z | (02) | CA |