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General NPI Number Information
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NPI Number | 1255594925
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Entity Type | Organization
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Legal Business Name | VALLEY RADIOTHERAPY ASSOCIATES MEDICAL GROUP INC
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Dates
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Enumeration Date | 07/03/2008
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Last Update Date | 07/03/2008
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Provider Practice Location Address
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Address Line | 101 E VALENCIA MESA DR
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City | FULLERTON
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State | CA
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Zip | 92835-3809
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Country | US
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Telephone | 714-446-5632
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Fax | 714-992-3081
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Provider Business Mailing Address
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Address Line | PO BOX 10050
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City | MANHATTAN BEACH
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State | CA
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Zip | 90267-7550
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Country | US
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Telephone | 310-335-4056
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Fax | 310-335-4098
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Authorized Official
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Title or Position | CEO
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Name | LESLIE E BOTNICK
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Credential | MD
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Telephone | 310-335-4065
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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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