Healthcare Provider Details

I. General information

NPI: 1215992748
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: 04/18/2006
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23961 CALLE DE LA MAGDALENA STE 500
LAGUNA HILLS CA
92653-7622
US

IV. Provider business mailing address

23961 CALLE DE LA MAGDALENA STE 500
LAGUNA HILLS CA
92653-7622
US

V. Phone/Fax

Practice location:
  • Phone: 949-855-1101
  • Fax: 949-855-8710
Mailing address:
  • Phone: 949-855-1101
  • Fax: 949-855-8710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

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