Basic Information
| Provider Information | |||||||||
| NPI: | 1134534795 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CBCC RADIATION ONCOLOGY | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 6501 TRUXTUN AVE | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933090633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613222206 | ||||||||
| FaxNumber: | 6613277027 | ||||||||
| Practice Location | |||||||||
| Address1: | 6501 TRUXTUN AVE | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933090633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613222206 | ||||||||
| FaxNumber: | 6613277027 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2014 | ||||||||
| LastUpdateDate: | 06/20/2018 | ||||||||
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| AuthorizedOfficialLastName: | KLAWITTER | ||||||||
| AuthorizedOfficialFirstName: | KJESTI | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF REIMBURSEMENT SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 6618627105 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.