1750604948 NPI number — UROLOGY CENTER OF SO CALIF MEDICAL GROUP INC

Table of content: (NPI 1750604948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750604948 NPI number — UROLOGY CENTER OF SO CALIF MEDICAL GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UROLOGY CENTER OF SO CALIF MEDICAL GROUP INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
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Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
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Provider Other Last Name:
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NPI Number Information

NPI Number:
1750604948
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1820 FULLERTON AVE
Provider Second Line Business Mailing Address:
#260
Provider Business Mailing Address City Name:
CORONA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92881-3160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28078 BAXTER RD
Provider Second Line Business Practice Location Address:
#314
Provider Business Practice Location Address City Name:
MURRIETA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92563-1402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-677-3000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/02/2010

Additional Information

Authorized Official

Authorized Official Last Name:
HOUMAN
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
951-735-2700

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , 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)





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