Healthcare Provider Details

I. General information

NPI: 1831129543
Provider Name (Legal Business Name): THERAPEUTIC RADIOLOGY MEDICAL ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 COFFEE RD DEPARTMENT OF RADIATION ONCOLOGY
MODESTO CA
95355-2803
US

IV. Provider business mailing address

1700 COFFEE RD DEPARTMENT OF RADIATION ONCOLOGY
MODESTO CA
95355-2803
US

V. Phone/Fax

Practice location:
  • Phone: 209-572-7237
  • Fax: 209-526-5280
Mailing address:
  • Phone: 209-572-7237
  • Fax: 209-526-5280

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. MANOUCH AZAD
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 209-572-7237