Provider Demographics
NPI:1891997250
Name:DESERT ROSE ONCOLOGY,LLC
Entity Type:Organization
Organization Name:DESERT ROSE ONCOLOGY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:INNA
Authorized Official - Middle Name:
Authorized Official - Last Name:OGANDZHANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-431-3547
Mailing Address - Street 1:PO BOX 13064
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85230-3064
Mailing Address - Country:US
Mailing Address - Phone:520-431-3547
Mailing Address - Fax:
Practice Address - Street 1:1281 E COTTONWOOD LN
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-2949
Practice Address - Country:US
Practice Address - Phone:520-431-3547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ286802085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G80717Medicare UPIN
71302Medicare ID - Type Unspecified