Provider Demographics
NPI:1245415538
Name:CYBERKNIFE OF SOUTHERN CALIFORNIA AT VISTA
Entity Type:Organization
Organization Name:CYBERKNIFE OF SOUTHERN CALIFORNIA AT VISTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:N
Authorized Official - Last Name:BOURBEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-599-9545
Mailing Address - Street 1:902 SYCAMORE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-7879
Mailing Address - Country:US
Mailing Address - Phone:760-599-9545
Mailing Address - Fax:760-599-9549
Practice Address - Street 1:902 SYCAMORE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-7879
Practice Address - Country:US
Practice Address - Phone:760-599-9545
Practice Address - Fax:760-599-9549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation