Healthcare Provider Details

I. General information

NPI: 1326113747
Provider Name (Legal Business Name): TEMECULA VALLEY RADIATION ONCOLOGY MED GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 08/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36320 INLAND VALLEY DR SUITE 105
WILDOMAR CA
92595-7512
US

IV. Provider business mailing address

36320 INLAND VALLEY DR SUITE 105
WILDOMAR CA
92595-7512
US

V. Phone/Fax

Practice location:
  • Phone: 951-200-6875
  • Fax: 951-200-6877
Mailing address:
  • Phone: 951-200-6875
  • Fax: 951-200-6877

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. FESTUS B DADA
Title or Position: OWNER/DIRECTOR
Credential: M.D.
Phone: 951-200-6875