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NPI Code Detail

MEDICARE: X-RAY MEDICAL GROUP RADIATION ONCOLOGY INC

MEDICARE: X-RAY MEDICAL GROUP RADIATION ONCOLOGY 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 : 1790724565
Entity Type Code : Organization
Provider Name (Legal Business Name) : X-RAY MEDICAL GROUP RADIATION ONCOLOGY INC
Provider Business Mailing Address
First Line : PO BOX 509015
Second Line : DEPT 338
City : SAN DIEGO
State : CA
Zip : 92150-9015
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5555 GROSSMONT CENTER DR
Second Line :
City : LA MESA
State : CA
Zip : 91942-3019
Country : US
Telephone Number : 619-740-4500
Fax Number : 619-740-8499
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : KELLY DEWITT
Credential : MD
Telephone Number : 619-740-4500
Provider Enumeration Date : 06/06/2006
Last Update Date : 02/17/2026

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