MEDICARE: RADIATION ONCOLOGY OF SAN ANTONIO, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CP7217	OTHER	TX	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184789232
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIATION ONCOLOGY OF SAN ANTONIO, PA

Provider Business Mailing Address
First Line	:	PO BOX 10050
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90267-7550
Country	:	US
Telephone Number	:	310-335-4056
Fax Number	:	310-335-4098

Provider Business Practice Location Address
First Line	:	215 E QUINCY ST
Second Line	:	STE B100
City	:	SAN ANTONIO
State	:	TX
Zip	:	78215-2039
Country	:	US
Telephone Number	:	210-299-8000
Fax Number	:	210-299-8099

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	RAJIV S. DAHIYA
Credential	:
Telephone Number	:	210-299-8000

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	02/25/2010

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