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NPI Code Detail

MEDICARE: NORTH VALLEY RADIATION ONCOLOGY MEDICAL GROUP INC

MEDICARE: NORTH VALLEY RADIATION ONCOLOGY 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 : 1972541530
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTH VALLEY RADIATION ONCOLOGY MEDICAL GROUP INC
Provider Business Mailing Address
First Line : PO BOX 511470
Second Line :
City : LOS ANGELES
State : CA
Zip : 90051-8025
Country : US
Telephone Number : 512-583-0205
Fax Number : 512-583-2001
Provider Business Practice Location Address
First Line : 2767 OLIVE HWY
Second Line :
City : OROVILLE
State : CA
Zip : 95966-6118
Country : US
Telephone Number : 530-891-8787
Fax Number : 530-345-4505
Authorized Official
Title or Position : PRESIDENT
Name : STEVEN WAHLEN
Credential : MD
Telephone Number : 530-891-8787
Provider Enumeration Date : 06/03/2006
Last Update Date : 02/09/2010

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