MEDICARE: CANCER TREATMENT SERVICES SAN DIEGO, LLC

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	261QX0203X	Radiation Oncology Clinic/Center

General Provider Information

NPI Number	:	1306083993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANCER TREATMENT SERVICES SAN DIEGO, LLC

Provider Business Mailing Address
First Line	:	5750 CENTRE AVE
Second Line	:	SUITE 300
City	:	PITTSBURGH
State	:	PA
Zip	:	15206-3721
Country	:	US
Telephone Number	:	412-204-1265
Fax Number	:	412-204-1299

Provider Business Practice Location Address
First Line	:	959 LANE AVE
Second Line	:	BUILDING B
City	:	CHULA VISTA
State	:	CA
Zip	:	91914-4528
Country	:	US
Telephone Number	:	619-502-7721
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOSEPH A. NICHOLAS
Credential	:
Telephone Number	:	412-204-1261

Provider Enumeration Date	:	01/19/2009
Last Update Date	:	01/19/2009

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