1437102092 NPI number — VALLEY RADIOTHERAPY ASSOCIATES MEDICAL GROUP INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437102092 NPI number — VALLEY RADIOTHERAPY ASSOCIATES MEDICAL GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY RADIOTHERAPY ASSOCIATES MEDICAL GROUP INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437102092
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10050
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANHATTAN BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90267-7550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-416-8956
Provider Business Mailing Address Fax Number:
310-536-9123

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 ROSECRANS AVE
Provider Second Line Business Practice Location Address:
400
Provider Business Practice Location Address City Name:
MANHATTAN BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90266-3763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-335-4056
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOTNICK
Authorized Official First Name:
LESLIE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CMO
Authorized Official Telephone Number:
310-335-4065

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CH4367 . This is a "RR MEDICARE ST. JUDE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR0013797 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR0013798 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR0013792 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR0013793 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR001379A , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR0013791 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR0013794 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR0013796 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CJ5668 . This is a "RR MEDICARE RIVERSIDE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR001379C , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR001379F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CR0476 . This is a "RR MEDICARE PSJ" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR001379E , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CP3272 . This is a "RRMEDICARE SJHC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DD9966 . This is a "RR MEDICARE EL CENTRO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR0013790 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR0013799 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR001379B , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR001379D , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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