1407052293 NPI number — L.A. UROLOGIY, INC.

Table of content: (NPI 1407052293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407052293 NPI number — L.A. UROLOGIY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
L.A. UROLOGIY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407052293
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8306 WILSHIRE BLVD
Provider Second Line Business Mailing Address:
SUITE #6700
Provider Business Mailing Address City Name:
BEVERLY HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90211-2304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-483-2772
Provider Business Mailing Address Fax Number:
213-484-6317

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14624 SHERMAN WAY
Provider Second Line Business Practice Location Address:
SUITE # 103
Provider Business Practice Location Address City Name:
VAN NUYS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-781-6620
Provider Business Practice Location Address Fax Number:
213-484-6317
Provider Enumeration Date:
06/27/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
BHARAT
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
213-483-2772

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  A34922 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)