Basic Information
| Provider Information | |||||||||
| NPI: | 1710495916 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALLIANCE ONCOLOGY OF ARIZONA, 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: | 9492425592 | ||||||||
| FaxNumber: | 6027733622 | ||||||||
| Practice Location | |||||||||
| Address1: | 7340 E THOMAS RD | ||||||||
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| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852517216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809456896 | ||||||||
| FaxNumber: | 4809457287 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2018 | ||||||||
| LastUpdateDate: | 01/30/2018 | ||||||||
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| AuthorizedOfficialLastName: | LONGMORE- GRUND | ||||||||
| AuthorizedOfficialFirstName: | RHONDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8005443215 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ALLIANCE ONCOLOGY OF ARIZONA, LLC | ||||||||
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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.