MEDICARE: NORTH COUNTY RADIATION ONCOLOGY

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

General Provider Information

NPI Number	:	1770581183
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH COUNTY RADIATION ONCOLOGY

Provider Business Mailing Address
First Line	:	916 SYCAMORE AVE
Second Line	:
City	:	VISTA
State	:	CA
Zip	:	92081-7815
Country	:	US
Telephone Number	:	760-599-9545
Fax Number	:	760-599-9549

Provider Business Practice Location Address
First Line	:	477 N EL CAMINO REAL
Second Line	:	STE D100
City	:	ENCINITAS
State	:	CA
Zip	:	92024-1328
Country	:	US
Telephone Number	:	760-634-4300
Fax Number	:	760-632-9791

Authorized Official
Title or Position	:	MANAGER
Name	:	ELIZABETH BOURBEAU
Credential	:
Telephone Number	:	760-599-9545

Provider Enumeration Date	:	07/09/2005
Last Update Date	:	10/25/2012

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Directions to “NORTH COUNTY RADIATION ONCOLOGY ” Practice Location

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