Healthcare Provider Details

I. General information

NPI: 1942348016
Provider Name (Legal Business Name): RADIATION ONCOLOGY ALLIANCE MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 06/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3630 E IMPERIAL HWY
LYNWOOD CA
90262-2636
US

IV. Provider business mailing address

PO BOX 67068
LOS ANGELES CA
90067-0068
US

V. Phone/Fax

Practice location:
  • Phone: 310-273-7365
  • Fax: 310-273-7366
Mailing address:
  • Phone: 310-273-7365
  • Fax: 310-273-7366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ARMAND BOUZAGLOU
Title or Position: PRINCIPAL
Credential: M.D
Phone: 213-484-7578