Basic Information
| Provider Information | |||||||||
| NPI: | 1497782692 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SANTA CLARITA RADIOTHERAPY MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 BAYVIEW CIR STE 400 | ||||||||
| Address2: | |||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926602984 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9492425300 | ||||||||
| FaxNumber: | 6027733622 | ||||||||
| Practice Location | |||||||||
| Address1: | 26357 MCBEAN PARKWAY | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | SANTA CLARITA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913551207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612885965 | ||||||||
| FaxNumber: | 6612885988 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | BENSON | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9492425300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | GR0101941 | 05 | CA | MEDICAID | GR0101940 | 05 | CA | MEDICAID |