Provider Demographics
NPI:1770598187
Name:SADDLEBACK RADIATION ONCOLOGY MEDICAL GROUP
Entity type:Organization
Organization Name:SADDLEBACK RADIATION ONCOLOGY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIAULLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-492-6695
Mailing Address - Street 1:2650 ELM AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1651
Mailing Address - Country:US
Mailing Address - Phone:562-492-6695
Mailing Address - Fax:562-988-0389
Practice Address - Street 1:24953 PASEO DE VALENCIA
Practice Address - Street 2:B-1
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4342
Practice Address - Country:US
Practice Address - Phone:949-452-7888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0065780Medicaid
HW13522Medicare ID - Type Unspecified