Healthcare Provider Details

I. General information

NPI: 1245542893
Provider Name (Legal Business Name): WESTSIDE ONCOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1328 22ND ST
SANTA MONICA CA
90404-2032
US

IV. Provider business mailing address

1500 ROSECRANS AVE SUITE 400
MANHATTAN BEACH CA
90266-3763
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-8913
  • Fax: 310-315-6168
Mailing address:
  • Phone: 310-416-8956
  • Fax: 310-335-4098

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. LESLIE E BOTNICK
Title or Position: CMO
Credential: MD
Phone: 310-335-4000