Provider Demographics
NPI:1710377296
Name:BURBANK BRACHYTHERAPY INSTITUTE INC
Entity Type:Organization
Organization Name:BURBANK BRACHYTHERAPY INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHARLACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-449-2700
Mailing Address - Street 1:2601 W ALAMEDA AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4800
Mailing Address - Country:US
Mailing Address - Phone:818-588-3840
Mailing Address - Fax:
Practice Address - Street 1:2601 W ALAMEDA AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4800
Practice Address - Country:US
Practice Address - Phone:818-588-3840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA196972085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty