Provider Demographics
NPI:1881685527
Name:WESTERN RADIATION ONCOLOGY INC
Entity Type:Organization
Organization Name:WESTERN RADIATION ONCOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:GUADALUPE
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-322-9958
Mailing Address - Street 1:2165 S BASCOM AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-3280
Mailing Address - Country:US
Mailing Address - Phone:209-342-2300
Mailing Address - Fax:209-524-4240
Practice Address - Street 1:100 S SAN MATEO DR
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3805
Practice Address - Country:US
Practice Address - Phone:209-342-2300
Practice Address - Fax:209-524-4240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0080592Medicaid
CAGR0080593Medicaid
CAGR0080590Medicaid
CAZZZ02838ZOtherBLUE SHIELD
CAZZZ02839ZOtherBLUE SHIELD
CAZZZ49854ZOtherBLUE SHIELD
CAZZZ52889YOtherBLUE SHIELD
CAZZZ02839ZOtherBLUE SHIELD
CAGR0080590Medicaid
CAZZZ52889YOtherBLUE SHIELD
CAGR0080592Medicaid
CAZZZ07586ZMedicare PIN