Healthcare Provider Details

I. General information

NPI: 1710377296
Provider Name (Legal Business Name): BURBANK BRACHYTHERAPY INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2015
Last Update Date: 02/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 W ALAMEDA AVE SUITE 300
BURBANK CA
91505-4800
US

IV. Provider business mailing address

2601 W ALAMEDA AVE SUITE 300
BURBANK CA
91505-4800
US

V. Phone/Fax

Practice location:
  • Phone: 818-588-3840
  • Fax:
Mailing address:
  • Phone: 818-588-3840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberA19697
License Number StateCA

VIII. Authorized Official

Name: RANDALL A SCHARLACH
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 818-449-2700