Provider Demographics
NPI:1225273998
Name:CARADONC INC
Entity Type:Organization
Organization Name:CARADONC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NARAYANA
Authorized Official - Middle Name:G
Authorized Official - Last Name:MEMULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-858-5902
Mailing Address - Street 1:1800 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92411-1218
Mailing Address - Country:US
Mailing Address - Phone:909-887-8800
Mailing Address - Fax:
Practice Address - Street 1:1800 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-1232
Practice Address - Country:US
Practice Address - Phone:909-887-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52162261QX0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO001014782Medicare PIN
MOE68262Medicare UPIN