Organization
LOS GATOS RADIATION ONCOLOGY MEDICAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ABBINAND VENKATA PEDDADA MD (PARTNER)
(209) 342-2300
Entity
Organization
Contact information
Practice address
15400 NATIONAL AVE, STE 100, LOS GATOS, CA 95032-2433
(209) 342-2300
(209) 524-4240
Mailing address
4301 NORTHSTAR WAY, MODESTO, CA 95356-9262
(209) 342-2300
(209) 524-4240
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0087740
—
CA
01
—
ZZZ62315Z
BLUE SHIELD
GA
Enumeration date
11/01/2005
Last updated
11/29/2007
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