Healthcare Provider Details

I. General information

NPI: 1316969207
Provider Name (Legal Business Name): ST. MARYS RADIATION ONCOLOGY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 03/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1043 ELM AVE SUITE 110
LONG BEACH CA
90813-3271
US

IV. Provider business mailing address

PO BOX 575
MURRIETA CA
92564-0575
US

V. Phone/Fax

Practice location:
  • Phone: 909-263-0321
  • Fax: 951-691-5156
Mailing address:
  • Phone: 951-691-5123
  • Fax: 951-691-5156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License NumberA23750
License Number StateCA

VIII. Authorized Official

Name: DEBBY CURRY
Title or Position: ACCOUNT MANAGER
Credential:
Phone: 951-691-5123