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General NPI Number Information
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NPI Number | 1083857940
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Entity Type | Organization
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Legal Business Name | PENINSULA CANCER CENTER LLC
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Dates
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Enumeration Date | 04/08/2009
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Last Update Date | 01/31/2017
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Provider Practice Location Address
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Address Line | 19917 7TH AVE NE
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City | POULSBO
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State | WA
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Zip | 98370-7403
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Country | US
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Telephone | 360-697-8000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 742322
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City | LOS ANGELES
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State | CA
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Zip | 90074-2322
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Country | US
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Telephone | 360-697-8000
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | NEZAM TOOLOEE
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Credential |
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Telephone | 206-755-1825
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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 |
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License Number State |
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