Basic Information
| Provider Information | |||||||||
| NPI: | 1326350950 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALLEY ONCOLOGY, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 ROSECRANS AVE | ||||||||
| Address2: | 400 | ||||||||
| City: | MANHATTAN BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902663763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103354000 | ||||||||
| FaxNumber: | 3103354096 | ||||||||
| Practice Location | |||||||||
| Address1: | 5522 SEPULVEDA BLVD | ||||||||
| Address2: | |||||||||
| City: | SHERMAN OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914113437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189971522 | ||||||||
| FaxNumber: | 8189970705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2010 | ||||||||
| LastUpdateDate: | 07/12/2010 | ||||||||
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| AuthorizedOfficialLastName: | BOTNICK | ||||||||
| AuthorizedOfficialFirstName: | LESLIE | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3103354000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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.