Provider Demographics
NPI:1184606162
Name:MARIN RADIATION ONCOLOGY MEDICAL GROUP
Entity type:Organization
Organization Name:MARIN RADIATION ONCOLOGY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR MEDICAL
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:TORIGOE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-342-2300
Mailing Address - Street 1:4301 NORTHSTAR WAY
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-9262
Mailing Address - Country:US
Mailing Address - Phone:209-342-2300
Mailing Address - Fax:209-524-4240
Practice Address - Street 1:1350 S ELISEO DR
Practice Address - Street 2:100
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2011
Practice Address - Country:US
Practice Address - Phone:209-342-2300
Practice Address - Fax:209-524-4240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0046360Medicaid
CAZZZ25782ZOtherBLUE SHIELD
CAGR0046360Medicaid
CAZZZ25782ZMedicare PIN