Healthcare Provider Details

I. General information

NPI: 1841503885
Provider Name (Legal Business Name): NORTHERN ARIZONA ONCOLOGY CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2010
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 GAIL GARDNER WAY
PRESCOTT AZ
86305-1690
US

IV. Provider business mailing address

PO BOX 60990
LOS ANGELES CA
90060-0990
US

V. Phone/Fax

Practice location:
  • Phone: 928-776-1040
  • Fax: 928-776-1041
Mailing address:
  • Phone: 310-335-4000
  • Fax: 310-335-4098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARK SHALVARJIAN
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 310-335-4000