Provider Demographics
NPI:1619162302
Name:DR. SULABHA DAVE M.D. INC.
Entity Type:Organization
Organization Name:DR. SULABHA DAVE M.D. INC.
Other - Org Name:RADIATION ONCOLOGY ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SULABHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-633-0836
Mailing Address - Street 1:2440 E SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-4426
Mailing Address - Country:US
Mailing Address - Phone:562-633-0836
Mailing Address - Fax:562-633-8345
Practice Address - Street 1:2440 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-4426
Practice Address - Country:US
Practice Address - Phone:562-633-0836
Practice Address - Fax:562-633-8345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30598261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center