Healthcare Provider Details

I. General information

NPI: 1770581183
Provider Name (Legal Business Name): NORTH COUNTY RADIATION ONCOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2005
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 N EL CAMINO REAL STE D100
ENCINITAS CA
92024-1328
US

IV. Provider business mailing address

916 SYCAMORE AVE
VISTA CA
92081-7815
US

V. Phone/Fax

Practice location:
  • Phone: 760-634-4300
  • Fax: 760-632-9791
Mailing address:
  • Phone: 760-599-9545
  • Fax: 760-599-9549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH BOURBEAU
Title or Position: MANAGER
Credential:
Phone: 760-599-9545