Provider Demographics
NPI:1770581183
Name:NORTH COUNTY RADIATION ONCOLOGY
Entity type:Organization
Organization Name:NORTH COUNTY RADIATION ONCOLOGY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOURBEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-599-9545
Mailing Address - Street 1:916 SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-7815
Mailing Address - Country:US
Mailing Address - Phone:760-599-9545
Mailing Address - Fax:760-599-9549
Practice Address - Street 1:477 N EL CAMINO REAL
Practice Address - Street 2:STE D100
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1328
Practice Address - Country:US
Practice Address - Phone:760-634-4300
Practice Address - Fax:760-632-9791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-09
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0062074Medicaid
CAWG38589EMedicare PIN
CAWG84902GMedicare PIN
CAWG28150QMedicare PIN
CAWA42436BMedicare PIN
CAWG72842JMedicare PIN
CAWA53741EMedicare PIN
CAWG67647QMedicare PIN
CAW16205Medicare PIN
CAGR0062074Medicaid
CAWA52748EMedicare PIN
CAWG50161EMedicare PIN
CAWA83272EMedicare PIN