Provider Demographics
NPI:1073754255
Name:ROTATING GAMMA INSTITUTE ORANGE
Entity Type:Organization
Organization Name:ROTATING GAMMA INSTITUTE ORANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-816-8705
Mailing Address - Street 1:3400 W. BALL ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3738
Mailing Address - Country:US
Mailing Address - Phone:714-816-8705
Mailing Address - Fax:
Practice Address - Street 1:3400 W BALL RD
Practice Address - Street 2:STE 101
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3738
Practice Address - Country:US
Practice Address - Phone:714-816-8705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7677-30261QX0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation