Basic Information
| Provider Information | |||||||||
| NPI: | 1255632063 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALLEY ONCOLOGY CENTERS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 30487 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900300487 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103354000 | ||||||||
| FaxNumber: | 3103354098 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 E 1ST ST | ||||||||
| Address2: | |||||||||
| City: | SPRING VALLEY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 613621512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8156644141 | ||||||||
| FaxNumber: | 8156631818 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2010 | ||||||||
| LastUpdateDate: | 02/11/2011 | ||||||||
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| AuthorizedOfficialLastName: | BOTNICK | ||||||||
| AuthorizedOfficialFirstName: | LESLIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3103354000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.