Provider Demographics
NPI:1467764092
Name:EMPIRE ONCOLOGY PC
Entity Type:Organization
Organization Name:EMPIRE ONCOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOTNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-335-4000
Mailing Address - Street 1:1500 ROSECRANS AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-3763
Mailing Address - Country:US
Mailing Address - Phone:310-416-8956
Mailing Address - Fax:310-335-4098
Practice Address - Street 1:44274 GEORGE CUSHMAN CT
Practice Address - Street 2:SUITE 110
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-5945
Practice Address - Country:US
Practice Address - Phone:951-252-9300
Practice Address - Fax:951-303-1800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty