1720009640 NPI number — TORRANCE RADIATION ONCOLOGY ASSOCIATES

Table of content: (NPI 1720009640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720009640 NPI number — TORRANCE RADIATION ONCOLOGY ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TORRANCE RADIATION ONCOLOGY ASSOCIATES
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:
1720009640
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 14556
Provider Second Line Business Mailing Address:
BUSINESS OFFICE
Provider Business Mailing Address City Name:
TORRANCE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90503-8556
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-517-4785
Provider Business Mailing Address Fax Number:
310-784-4820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 N PROSPECT AVE
Provider Second Line Business Practice Location Address:
#104
Provider Business Practice Location Address City Name:
REDONDO BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90277-3028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-374-5417
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SIMKO
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
310-374-5417

Provider Taxonomy Codes

  • Taxonomy code: 261QX0203X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GR0047010 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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