Provider Demographics
NPI:1194020156
Name:RED ROCKS RADIATION & ONCOLOGY, LLC
Entity Type:Organization
Organization Name:RED ROCKS RADIATION & ONCOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GOVERNMENT ENROLLMENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHNETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-242-5584
Mailing Address - Street 1:18201 VON KARMAN AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-1176
Mailing Address - Country:US
Mailing Address - Phone:949-242-5584
Mailing Address - Fax:
Practice Address - Street 1:400 INDIANA ST STE 220
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-5046
Practice Address - Country:US
Practice Address - Phone:720-420-3300
Practice Address - Fax:720-420-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty