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NPI Code Detail

MEDICARE: VALLEY RADIOTHERAPY ASSOCIATES MEDICAL GROUP INC

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
12085R0001XRadiation Oncology Physician

General Provider Information

NPI Number : 1598928152
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 : 310-335-4056
Fax Number : 310-335-4098
Provider Business Practice Location Address
First Line : 5522 SEPULVEDA BLVD
Second Line :
City : SHERMAN OAKS
State : CA
Zip : 91411-3437
Country : US
Telephone Number : 818-997-1522
Fax Number : 818-997-0705
Authorized Official
Title or Position : CEO
Name : LESLIE E BOTNICK
Credential : MD
Telephone Number : 310-335-4065
Provider Enumeration Date : 07/03/2008
Last Update Date : 07/03/2008

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Practice Location Address:
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1427158245 — RICHARD D DAVID M.D.
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1891822045 — MRS. SUSAN SALZWEDEL PA-C
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1205164068 — PAMELA MIURA L.AC.
Practice Location Address:
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Practice Phone: 818-988-7988
Practice Fax: 818-988-7588

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