MEDICARE: NORCAL UROLOGY MEDICAL 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		CA

General Provider Information

NPI Number	:	1447447446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORCAL UROLOGY MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	3300 WEBSTER ST
Second Line	:	SUITE 710
City	:	OAKLAND
State	:	CA
Zip	:	94609-3117
Country	:	US
Telephone Number	:	510-465-5800
Fax Number	:	510-839-8984

Provider Business Practice Location Address
First Line	:	5201 NORRIS CANYON RD
Second Line	:	SUITE 230
City	:	SAN RAMON
State	:	CA
Zip	:	94583-5411
Country	:	US
Telephone Number	:	925-866-2100
Fax Number	:	510-866-6612

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. PAUL F DEVIVO
Credential	:
Telephone Number	:	510-465-5800

Provider Enumeration Date	:	10/03/2007
Last Update Date	:	06/28/2010

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