MEDICARE: UNIVERSITY CANCER CENTER, 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	2085R0203X	Therapeutic Radiology Physician

General Provider Information

NPI Number	:	1407092711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY CANCER CENTER, LLC

Provider Business Mailing Address
First Line	:	PO BOX 190
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93062-0190
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1881 W ORANGE GROVE RD.
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-1116
Country	:	US
Telephone Number	:	805-577-2021
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID COHEN
Credential	:
Telephone Number	:	818-879-9600

Provider Enumeration Date	:	12/17/2008
Last Update Date	:	12/17/2008

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