NPIMap

Organization Active NPI

Coastal Radiation Oncology Medical Group, Inc.

Doing business as San Luis Radiation Oncology Medical Center, Inc.

  • Radiation Oncology Physician
  • San Luis Obispo, CA
National Provider Identifier
1730111931
Registry record updated Jan 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
Legal business name
COASTAL RADIATION ONCOLOGY MEDICAL GROUP, INC.
Doing business as
San Luis Radiation Oncology Medical Center, Inc.
Practice address
100 Casa St
Suite C
San Luis Obispo, CA 93405-1883
Phone
(805) 541-1932
Fax
(805) 541-1653
NPI assigned
Jul 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2008

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

Authorized official

Name
Dr. Jonathan R Stella, M.D.
Title
President
Phone
(805) 541-1932

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0001X Primary

Addresses

Primary practice location

100 Casa St
Suite C
San Luis Obispo, CA 93405-1883

Mailing address

Dept 9697
Los Angeles, CA 90084-9697
Phone (949) 721-6520

Other identifiers 1

IdentifierTypeStateIssuer
GR0005751MedicaidCA

Other names 1

  • San Luis Radiation Oncology Medical Center, Inc. Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Coastal Radiation Oncology Medical Group Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201564800000",
    "number": "1730111931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPT 9697",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900849697",
            "telephone_number": "949-721-6520",
            "fax_number": "949-721-6120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 CASA ST",
            "address_2": "SUITE C",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934051883",
            "telephone_number": "805-541-1932",
            "fax_number": "805-541-1653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL RADIATION ONCOLOGY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2008-01-29",
        "status": "A",
        "authorized_official_last_name": "STELLA",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "805-541-1932",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Radiation Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0005751",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Luis Radiation Oncology Medical Center, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Luis Obispo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 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.