Healthcare Provider Details

I. General information

NPI: 1346638327
Provider Name (Legal Business Name): ADVANCED THERMAL ASSOCIATES A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2014
Last Update Date: 12/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 WILSHIRE BLVD SUITE 860
SANTA MONICA CA
90403-4803
US

IV. Provider business mailing address

2811 WILSHIRE BLVD SUITE 860
SANTA MONICA CA
90403-4803
US

V. Phone/Fax

Practice location:
  • Phone: 888-580-5900
  • Fax:
Mailing address:
  • Phone: 888-580-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: OSCAR EDWARD STREETER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 202-697-3182