Healthcare Provider Details

I. General information

NPI: 1922038009
Provider Name (Legal Business Name): COASTAL RADIATION ONCOLOGY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 LOMA VISTA RD 100
VENTURA CA
93003-2920
US

IV. Provider business mailing address

2900 LOMA VISTA RD 100
VENTURA CA
93003-2907
US

V. Phone/Fax

Practice location:
  • Phone: 805-648-5191
  • Fax: 805-648-3458
Mailing address:
  • Phone: 805-648-5191
  • Fax: 805-648-3458

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. JEFFREY M RODNICK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 805-648-5191