Healthcare Provider Details

I. General information

NPI: 1528233905
Provider Name (Legal Business Name): VALLEY RADIOTHERAPY ASSOCIATES MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 09/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

799 E. HAMPDEN AVENUE
ENGLEWOOD CO
80113-2700
US

IV. Provider business mailing address

4704 HARLAN STREET SUITE 511
DENVER CO
80212-7427
US

V. Phone/Fax

Practice location:
  • Phone: 303-788-5860
  • Fax: 303-788-7325
Mailing address:
  • Phone: 720-382-1008
  • Fax: 720-382-1012

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 ELIOTT BOTNICK
Title or Position: CEO
Credential: M.D.
Phone: 310-335-4056