Provider Demographics
NPI:1174594386
Name:LOS ANGELES RADIATION ONCOLOGY MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:LOS ANGELES RADIATION ONCOLOGY MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTANESI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-573-9500
Mailing Address - Street 1:PO BOX 4085
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92781-4085
Mailing Address - Country:US
Mailing Address - Phone:714-573-9500
Mailing Address - Fax:714-573-9505
Practice Address - Street 1:14642 NEWPORT AVE
Practice Address - Street 2:#470
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6057
Practice Address - Country:US
Practice Address - Phone:714-573-9500
Practice Address - Fax:714-573-9505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0092810Medicaid
CAW16207Medicare ID - Type Unspecified
CAGR0092810Medicaid