Healthcare Provider Details

I. General information

NPI: 1073528774
Provider Name (Legal Business Name): CALIFORNIA RADIATION ONCOLOGY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 ATLANTIC AVE
LONG BEACH CA
90806-1701
US

IV. Provider business mailing address

2650 ELM AVE SUITE 201
LONG BEACH CA
90806-1651
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-0300
  • Fax: 562-933-0301
Mailing address:
  • Phone: 562-492-6695
  • Fax: 562-988-0389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. SYED ZIAULLA
Title or Position: ADMINISTRATOR
Credential:
Phone: 562-492-6695