Provider Demographics
NPI:1184924193
Name:GOLDEN STATE RADIATION ONCOLOGY, INC
Entity type:Organization
Organization Name:GOLDEN STATE RADIATION ONCOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
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 1:104 WOODMONT BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2245
Mailing Address - Country:US
Mailing Address - Phone:713-589-6879
Mailing Address - Fax:713-795-5081
Practice Address - Street 1:21300 ERWIN ST
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1950
Practice Address - Country:US
Practice Address - Phone:424-249-7500
Practice Address - Fax:818-610-7461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA713582085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHC599AOtherMEDICARE
EB761AMedicare PIN
CAEB761BMedicare UPIN
CAFL338ZMedicare UPIN