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General NPI Number Information
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NPI Number | 1720290968
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Entity Type | Organization
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Legal Business Name | FOUR CORNERS RADIATION ONCOLOGY PC
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 800 W MAPLE
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City | FARMINGTON
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State | NM
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Zip | 87401
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Country | US
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Telephone | 505-599-6105
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1956
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City | FARMINGTON
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State | NM
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Zip | 87499
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Country | US
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Telephone | 505-334-0622
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Fax | 505-334-0622
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Authorized Official
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Title or Position | OWNER
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Name | DR. LINH NGOC NGUYEN
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Credential | M.D.
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Telephone | 505-599-6105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471R0002X
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Taxonomy Name | Radiation Therapy Radiologic Technologist
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License Number | MD2004-0204
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License Number State | NM
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