Healthcare Provider Details

I. General information

NPI: 1861656308
Provider Name (Legal Business Name): WASHINGTON RADIATION ONCOLOGY CENTER, A MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39101 CIVIC CENTER DR
FREMONT CA
94538-5817
US

IV. Provider business mailing address

39101 CIVIC CENTER DR
FREMONT CA
94538-5817
US

V. Phone/Fax

Practice location:
  • Phone: 510-796-7212
  • Fax: 510-745-6469
Mailing address:
  • Phone: 510-796-7212
  • Fax: 510-745-6469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberG36600
License Number StateCA

VIII. Authorized Official

Name: ALBERT L. BROOKS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 510-795-2026