MEDICARE: VALLEY RADIOTHERAPY ASSOCIATES MEDICAL GROUP INC

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	CH4367	OTHER	CA	RR MEDICARE ST. JUDE
10	CJ5668	OTHER	CA	RR MEDICARE RIVERSIDE
13	CR0476	OTHER	CA	RR MEDICARE PSJ
15	CP3272	OTHER	CA	RRMEDICARE SJHC
16	DD9966	OTHER	CA	RR MEDICARE EL CENTRO

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
17	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
18	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
19	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
20	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437102092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY RADIOTHERAPY ASSOCIATES MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	PO BOX 10050
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90267-7550
Country	:	US
Telephone Number	:	310-416-8956
Fax Number	:	310-536-9123

Provider Business Practice Location Address
First Line	:	1500 ROSECRANS AVE
Second Line	:	400
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-3763
Country	:	US
Telephone Number	:	310-335-4056
Fax Number	:

Authorized Official
Title or Position	:	CMO
Name	:	DR. LESLIE E BOTNICK
Credential	:	MD
Telephone Number	:	310-335-4065

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	03/06/2014

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