1770736456 NPI number — UROGYNECOLOGY ASSOCIATES MEDICAL CORPORATION

Table of content: (NPI 1770736456)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770736456 NPI number — UROGYNECOLOGY ASSOCIATES MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UROGYNECOLOGY ASSOCIATES MEDICAL CORPORATION
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:
1770736456
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25108 MARGUERITE PKWY
Provider Second Line Business Mailing Address:
A-259
Provider Business Mailing Address City Name:
MISSION VIEJO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92692-2400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-839-8676
Provider Business Mailing Address Fax Number:
714-839-8676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
307 E 1ST ST
Provider Second Line Business Practice Location Address:
1C
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92701-5302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-839-8676
Provider Business Practice Location Address Fax Number:
714-839-8675
Provider Enumeration Date:
10/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BONNI
Authorized Official First Name:
ARAM
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
760-265-4500

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 11404859164 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: A66385 . This is a "CALIFORNIA MEDICAL LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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