Provider Demographics
NPI:1073528774
Name:CALIFORNIA RADIATION ONCOLOGY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:CALIFORNIA RADIATION ONCOLOGY MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIAULLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-492-6695
Mailing Address - Street 1:2650 ELM AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1651
Mailing Address - Country:US
Mailing Address - Phone:562-492-6695
Mailing Address - Fax:562-988-0389
Practice Address - Street 1:2801 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1701
Practice Address - Country:US
Practice Address - Phone:562-933-0300
Practice Address - Fax:562-933-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ80551ZMedicaid
CAZZZ80551ZMedicaid