Healthcare Provider Details

I. General information

NPI: 1417449984
Provider Name (Legal Business Name): SMART RADIATION THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2018
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2827 WILSHIRE BLVD
SANTA MONICA CA
90403-4801
US

IV. Provider business mailing address

2827 WILSHIRE BLVD
SANTA MONICA CA
90403-4801
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-9788
  • Fax: 310-584-9999
Mailing address:
  • Phone: 310-829-9788
  • Fax: 310-584-9999

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: BRADLEY JABOUR
Title or Position: OWNER
Credential: M.D.
Phone: 310-829-9788