Provider Demographics
NPI:1942348016
Name:RADIATION ONCOLOGY ALLIANCE MEDICAL GROUP INC
Entity Type:Organization
Organization Name:RADIATION ONCOLOGY ALLIANCE MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:ARMAND
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUZAGLOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-484-7578
Mailing Address - Street 1:PO BOX 67068
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-0068
Mailing Address - Country:US
Mailing Address - Phone:310-273-7365
Mailing Address - Fax:310-273-7366
Practice Address - Street 1:3630 E IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-2636
Practice Address - Country:US
Practice Address - Phone:310-273-7365
Practice Address - Fax:310-273-7366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHW14711AMedicare PIN