Provider Demographics
NPI:1710322946
Name:SUN ELECTRONIC BRACHYTHERAPY INC
Entity Type:Organization
Organization Name:SUN ELECTRONIC BRACHYTHERAPY INC
Other - Org Name:ARIZONA ONCOLOGY NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANNTEJ
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:SRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-705-1353
Mailing Address - Street 1:8380 W EMILE ZOLA AVE
Mailing Address - Street 2:SUITE 5115
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4811
Mailing Address - Country:US
Mailing Address - Phone:602-802-8700
Mailing Address - Fax:602-802-8799
Practice Address - Street 1:6424 E BROADWAY RD
Practice Address - Street 2:SUITE 104 & 105
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1750
Practice Address - Country:US
Practice Address - Phone:602-802-8700
Practice Address - Fax:602-802-8799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35361207RH0003X
AZ280332085N0904X, 2085R0202X
AZ309402085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty