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General NPI Number Information
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NPI Number | 1043399397
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Entity Type | Organization
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Legal Business Name | USCC AQUISITION CORP
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | DEPT 9536
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City | LOS ANGELES
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State | CA
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Zip | 90084-9536
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Country | US
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Telephone | 949-721-6521
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Fax |
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Provider Business Mailing Address
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Address Line | 900 GREENLEY RD SUITE 901
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City | SONORA
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State | CA
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Zip | 95370-5287
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Country | US
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Telephone | 949-721-6521
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | GARY S. YOUNG
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Credential | MD
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Telephone | 949-721-6521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | G61579
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License Number State | CA
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