1437312105 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 1437312105 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:
1437312105
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/03/2008
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:
310-335-4056
Provider Business Mailing Address Fax Number:
310-335-4098

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5529 RESEDA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TARZANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91356-2611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-774-2860
Provider Business Practice Location Address Fax Number:
818-774-2869
Provider Enumeration Date:
07/03/2008

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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