Healthcare Provider Details

I. General information

NPI: 1952229700
Provider Name (Legal Business Name): COMPREHENSIVE UROLOGY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8631 W 3RD ST STE 1115E
LOS ANGELES CA
90048-5901
US

IV. Provider business mailing address

8631 W 3RD ST STE 1115E
LOS ANGELES CA
90048-5901
US

V. Phone/Fax

Practice location:
  • Phone: 310-278-8330
  • Fax: 310-278-7595
Mailing address:
  • Phone: 310-278-8330
  • Fax: 310-278-7595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: ARDITH CORTES
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 310-461-0226