Healthcare Provider Details

I. General information

NPI: 1194100172
Provider Name (Legal Business Name): LOW TESTOSTERONE MEDICAL GROUP OF CALIFORNIA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 07/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

947 S ANAHEIM BLVD STE 270
ANAHEIM CA
92805-5584
US

IV. Provider business mailing address

947 S ANAHEIM BLVD STE 270
ANAHEIM CA
92805-5584
US

V. Phone/Fax

Practice location:
  • Phone: 714-533-1491
  • Fax: 714-533-0237
Mailing address:
  • Phone: 714-533-1491
  • Fax: 714-533-0237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA67110
License Number StateCA

VIII. Authorized Official

Name: DAVID TODD ASHER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-533-1491