Healthcare Provider Details

I. General information

NPI: 1386156842
Provider Name (Legal Business Name): ORANGE COUNTY UROLOGY ASSOCIATES INC. A MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16305 SAND CANYON AVE STE 200
IRVINE CA
92618-3783
US

IV. Provider business mailing address

25200 LA PAZ RD STE 200
LAGUNA HILLS CA
92653-5134
US

V. Phone/Fax

Practice location:
  • Phone: 949-855-1101
  • Fax:
Mailing address:
  • Phone: 949-855-1101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: LARRY SILVIA
Title or Position: COO
Credential:
Phone: 949-855-1101