Organization
ONCOLOGY THERAPIES OF VISTA MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH N BOURBEAU (MANAGER)
(760) 599-9545
Entity
Organization
Contact information
Practice address
916 SYCAMORE AVE, VISTA, CA 92081-7815
(760) 599-9545
(760) 599-9549
Mailing address
916 SYCAMORE AVE, VISTA, CA 92081-7815
(760) 599-9545
(760) 599-9549
Taxonomy
Speciality
Code
Description
License number
State
261QX0203X
Radiation Oncology Clinic/Center
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A42436A0
—
CA
05
—
00A537410
—
CA
05
—
00A830540
—
CA
05
—
00G676470
—
CA
Enumeration date
11/29/2006
Last updated
01/08/2008
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