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General NPI Number Information
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NPI Number | 1972535359
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Entity Type | Organization
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Legal Business Name | COASTAL RADIATION ONCOLOGY MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 01/29/2008
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Provider Practice Location Address
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Address Line | 274 HEATHER CT
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City | TEMPLETON
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State | CA
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Zip | 93465-9738
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Country | US
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Telephone | 805-434-1859
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Fax | 805-434-2383
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Provider Business Mailing Address
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Address Line | DEPT. 9697
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City | LOS ANGELES
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State | CA
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Zip | 90084-9697
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Country | US
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Telephone | 949-721-6520
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Fax | 949-721-6120
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JONATHAN R STELLA
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Credential | M.D.
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Telephone | 805-541-1932
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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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