Healthcare Provider Details

I. General information

NPI: 1093753055
Provider Name (Legal Business Name): NORTH VALLEY RADIATION MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 ESPLANADE
CHICO CA
95926-3310
US

IV. Provider business mailing address

PO BOX 511470
LOS ANGELES CA
90051-8025
US

V. Phone/Fax

Practice location:
  • Phone: 530-891-8787
  • Fax: 530-345-4505
Mailing address:
  • Phone: 512-583-0205
  • Fax: 512-583-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN WAHLEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 530-891-8787