Healthcare Provider Details

I. General information

NPI: 1639509706
Provider Name (Legal Business Name): MEMORIAL RADIATION ONCOLOGY MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2013
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18111 BROOKHURST ST SUITE LL0300
FOUNTAIN VALLEY CA
92708-6728
US

IV. Provider business mailing address

PO BOX 844945
LOS ANGELES CA
90084-4945
US

V. Phone/Fax

Practice location:
  • Phone: 714-962-7100
  • Fax: 714-963-7600
Mailing address:
  • Phone: 562-492-6695
  • Fax: 562-988-0389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ASIF R. HARSOLIA
Title or Position: MD/AUTHORIZED OFFICIAL
Credential: MD
Phone: 562-492-6695