Provider Demographics
NPI:1497782692
Name:SANTA CLARITA RADIOTHERAPY MEDICAL GROUP
Entity Type:Organization
Organization Name:SANTA CLARITA RADIOTHERAPY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-242-5300
Mailing Address - Street 1:100 BAYVIEW CIR STE 400
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2984
Mailing Address - Country:US
Mailing Address - Phone:949-242-5300
Mailing Address - Fax:602-773-3622
Practice Address - Street 1:26357 MCBEAN PARKWAY
Practice Address - Street 2:SUITE 150
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91355-1207
Practice Address - Country:US
Practice Address - Phone:661-288-5965
Practice Address - Fax:661-288-5988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0101941Medicaid
CAGR0101940Medicaid
CAW19112Medicare ID - Type Unspecified