Healthcare Provider Details

I. General information

NPI: 1528006228
Provider Name (Legal Business Name): NORTH VALLEY RADIATION ONCOLOGY MEDCIAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 02/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 OLIVE HWY SUITE 110
OROVILLE CA
95966-6131
US

IV. Provider business mailing address

PO BOX 511470
LOS ANGELES CA
90051-8025
US

V. Phone/Fax

Practice location:
  • Phone: 530-891-8787
  • Fax: 530-345-4505
Mailing address:
  • Phone: 512-583-0205
  • Fax: 512-583-2001

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: STEVEN WAHLEN
Title or Position: PRESIDENT
Credential: MD
Phone: 530-891-8787