Healthcare Provider Details

I. General information

NPI: 1720234081
Provider Name (Legal Business Name): COMPASSIONATE CANCER CARE RADIATION DIAGNOSTICS GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 01/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 E ONTARIO AVE STE 101
CORONA CA
92879-3508
US

IV. Provider business mailing address

260 E ONTARIO AVE STE 101
CORONA CA
92879-3508
US

V. Phone/Fax

Practice location:
  • Phone: 951-371-2411
  • Fax: 951-284-0177
Mailing address:
  • Phone: 951-371-2411
  • Fax: 951-284-0177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: HARESH S JHANGIANI
Title or Position: PRESIDENT
Credential: MD
Phone: 951-371-2411