MEDICARE: MEMORIAL RADIATION ONCOLOGY MEDICAL

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	2085R0001X	Radiation Oncology Physician

General Provider Information

NPI Number	:	1306267380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEMORIAL RADIATION ONCOLOGY MEDICAL

Provider Business Mailing Address
First Line	:	PO BOX 844945
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90084-4945
Country	:	US
Telephone Number	:	562-492-6695
Fax Number	:	562-988-0389

Provider Business Practice Location Address
First Line	:	24302 PASEO DE VALENCIA
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-3115
Country	:	US
Telephone Number	:	949-452-8880
Fax Number	:	949-859-5980

Authorized Official
Title or Position	:	MD/AUTHORIZED OFFICIAL
Name	:	ASIF R. HARSOLIA
Credential	:	MD
Telephone Number	:	562-492-6695

Provider Enumeration Date	:	12/18/2013
Last Update Date	:	02/22/2023

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