Organization
COASTAL RADIATION ONCOLOGY MEDICAL GROUP, INC.
Active
Other names
San Luis Radiation Oncology Medical Center, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN R STELLA M.D. (PRESIDENT)
(805) 541-1932
Entity
Organization
Contact information
Practice address
100 CASA ST, SUITE C, SAN LUIS OBISPO, CA 93405-1883
(805) 541-1932
(805) 541-1653
Mailing address
DEPT 9697, LOS ANGELES, CA 90084-9697
(949) 721-6520
(949) 721-6120
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0005751
—
CA
Enumeration date
07/07/2006
Last updated
01/29/2008
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