Healthcare Provider Details

I. General information

NPI: 1144417148
Provider Name (Legal Business Name): NORCAL UROLOGY MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S SHORE CTR W SUITE 103
ALAMEDA CA
94501-5762
US

IV. Provider business mailing address

3300 WEBSTER ST SUITE 710
OAKLAND CA
94609-3117
US

V. Phone/Fax

Practice location:
  • Phone: 510-523-0273
  • Fax: 510-523-3233
Mailing address:
  • Phone: 510-465-5800
  • Fax: 510-839-8984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: PAUL F DEVIVO
Title or Position: ADMINISTRATOR
Credential:
Phone: 510-465-5800