Oncology Therapies of Vista Medical Group, Inc

Primary specialty

Radiation Oncology Clinic/CenterTaxonomy code 261QX0203X

Legal business name

ONCOLOGY THERAPIES OF VISTA MEDICAL GROUP, INC

Practice address

916 Sycamore Ave
Vista, CA 92081-7815

Phone

(760) 599-9545

Fax

(760) 599-9549

NPI assigned

Nov 29, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Elizabeth N Bourbeau

Title

Manager

Phone

(760) 599-9545

Specialties & licenses 1

Addresses

Other identifiers 4

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199750400000",
    "number": "1265509657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "916 SYCAMORE AVE",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920817815",
            "telephone_number": "760-599-9545",
            "fax_number": "760-599-9549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "916 SYCAMORE AVE",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920817815",
            "telephone_number": "760-599-9545",
            "fax_number": "760-599-9549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ONCOLOGY THERAPIES OF VISTA MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2008-01-08",
        "status": "A",
        "authorized_official_last_name": "BOURBEAU",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "760-599-9545"
    },
    "taxonomies": [
        {
            "code": "261QX0203X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oncology, Radiation",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A42436A0",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A537410",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A830540",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G676470",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Beth Ann Olsen
• Meghan Marie Olsen
• Robert Don Olson, D.C.,
• Vanessa Renee Olson
• Olympus Movement Performance
• Gerald William Ondash, MD
• Amy Oneill, CLINICAL/MFT
• Donald Lim Ong, MD
• Patricia Kay Oquist, M.F.T.
• Mayrene Oregon

• Radiation Oncology Clinic/Center in Vista, CA
• Providers in Vista, CA by specialty
• Radiation Oncology Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.