Provider Demographics
NPI:1831503812
Name:NEWPORT BRACHYTHERAPY INSTITUTE, INC.
Entity type:Organization
Organization Name:NEWPORT BRACHYTHERAPY INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SCHARLACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-449-2700
Mailing Address - Street 1:369 SAN MIGUEL DR
Mailing Address - Street 2:SUITE 235
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7818
Mailing Address - Country:US
Mailing Address - Phone:949-706-2887
Mailing Address - Fax:
Practice Address - Street 1:369 SAN MIGUEL DR
Practice Address - Street 2:SUITE 235
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7818
Practice Address - Country:US
Practice Address - Phone:949-706-2887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-17
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA808902085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty