MEDICARE: VALLEY ASSOCIATED UROLOGY MEDICARE GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225073588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY ASSOCIATED UROLOGY MEDICARE GROUP INC

Provider Business Mailing Address
First Line	:	1541 FLORIDA AVE
Second Line	:	STE 306
City	:	MODESTO
State	:	CA
Zip	:	95350-4429
Country	:	US
Telephone Number	:	209-521-0870
Fax Number	:	209-521-0398

Provider Business Practice Location Address
First Line	:	200 COTTAGE AVE
Second Line	:	STE 101
City	:	MANTECA
State	:	CA
Zip	:	95336-4935
Country	:	US
Telephone Number	:	209-239-2197
Fax Number	:	209-239-7672

Authorized Official
Title or Position	:	CHIEF ADMINISTRATIVE OFFICER
Name	:	MR. GERALD BOYAJIAN
Credential	:
Telephone Number	:	209-521-0870

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	09/13/2007

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