1770581183 NPI number — NORTH COUNTY RADIATION ONCOLOGY

Table of content: (NPI 1770581183)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770581183 NPI number — NORTH COUNTY RADIATION ONCOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH COUNTY RADIATION ONCOLOGY
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:
6
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:
1770581183
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
916 SYCAMORE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VISTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92081-7815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-599-9545
Provider Business Mailing Address Fax Number:
760-599-9549

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
477 N EL CAMINO REAL
Provider Second Line Business Practice Location Address:
STE D100
Provider Business Practice Location Address City Name:
ENCINITAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92024-1328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-634-4300
Provider Business Practice Location Address Fax Number:
760-632-9791
Provider Enumeration Date:
07/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BOURBEAU
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
760-599-9545

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: GR0062074 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com