Healthcare Provider Details

I. General information

NPI: 1982631412
Provider Name (Legal Business Name): UROLOGY CENTER OF SOUTHERN CALIFORNIA MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28078 BAXTER RD #450
MURRIETA CA
92563-1402
US

IV. Provider business mailing address

801 S MAIN ST STE 201
CORONA CA
92882-3410
US

V. Phone/Fax

Practice location:
  • Phone: 951-677-3000
  • Fax: 951-672-4171
Mailing address:
  • Phone: 951-735-2700
  • Fax: 951-735-7564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. MADHUMITHA C REDDY
Title or Position: CFO
Credential: D.O.
Phone: 951-677-3000