Basic Information
| Provider Information | |||||||||
| NPI: | 1326690827 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RED ROCKS RADIATION & ONCOLOGY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18201 VON KARMAN AVE STE 600 | ||||||||
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| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926121176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9492425584 | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 INDIANA ST STE 220 | ||||||||
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| City: | GOLDEN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804015046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7204203300 | ||||||||
| FaxNumber: | 7204203301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2019 | ||||||||
| LastUpdateDate: | 07/15/2019 | ||||||||
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| AuthorizedOfficialLastName: | TRAYLOR | ||||||||
| AuthorizedOfficialFirstName: | JOHNETTA | ||||||||
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| AuthorizedOfficialTitleorPosition: | GOVERNMENT ENROLLMENT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9492425584 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.