Healthcare Provider Details

I. General information

NPI: 1013299817
Provider Name (Legal Business Name): YUMA REGIONAL CANCER CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 S RIDGEVIEW DR
YUMA AZ
85364-8868
US

IV. Provider business mailing address

2400 S AVENUE A
YUMA AZ
85364-7127
US

V. Phone/Fax

Practice location:
  • Phone: 928-317-2518
  • Fax: 928-317-1811
Mailing address:
  • Phone: 928-317-2518
  • Fax: 928-317-1811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: RONDA SEUBERT
Title or Position: PRACTICE SUPERVISOR
Credential:
Phone: 928-317-2518