Provider Demographics
NPI:1407861818
Name:MOJAVE RADIATION ONCOLOGY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:MOJAVE RADIATION ONCOLOGY MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MUNTHER
Authorized Official - Middle Name:E
Authorized Official - Last Name:ALQAISI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-492-6695
Mailing Address - Street 1:104 WOODMONT BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2245
Mailing Address - Country:US
Mailing Address - Phone:562-492-6695
Mailing Address - Fax:949-612-8255
Practice Address - Street 1:18280 SISKIYOU RD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1413
Practice Address - Country:US
Practice Address - Phone:760-242-1372
Practice Address - Fax:760-242-1127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9673134Medicaid
CAGR0050110Medicaid
ZZZ28619ZMedicare ID - Type Unspecified
CAGR0050110Medicaid