Healthcare Provider Details

I. General information

NPI: 1275547127
Provider Name (Legal Business Name): NOR CAL UROLOGY MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 WEBSTER ST STE 710
OAKLAND CA
94609-3122
US

IV. Provider business mailing address

3300 WEBSTER ST STE 710
OAKLAND CA
94609-3122
US

V. Phone/Fax

Practice location:
  • Phone: 510-465-5800
  • Fax: 510-267-1833
Mailing address:
  • Phone: 510-465-5800
  • Fax: 510-267-1833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: BRANDON BOOTS
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 510-213-2261