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General NPI Number Information
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NPI Number | 1932135472
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Entity Type | Organization
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Legal Business Name | MISSION VIEJO RADIATION ONCOLOGY CORP.
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 03/11/2020
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Provider Practice Location Address
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Address Line | 27799 MEDICAL CENTER RD STE 120
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6426
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Country | US
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Telephone | 949-573-9560
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 515445
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City | LOS ANGELES
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State | CA
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Zip | 90051-6745
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Country | US
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Telephone | 949-573-9560
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CAROLYN YOUNG
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Credential | MD
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Telephone | 949-573-9560
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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 | G49709
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License Number State | CA
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