Healthcare Provider Details

I. General information

NPI: 1467369512
Provider Name (Legal Business Name): FOOTHILL UROLOGY SPECIALISTS, A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 N ORANGE GROVE AVE STE 101
POMONA CA
91767-3028
US

IV. Provider business mailing address

1818 N ORANGE GROVE AVE STE 101
POMONA CA
91767-3028
US

V. Phone/Fax

Practice location:
  • Phone: 909-236-3333
  • Fax:
Mailing address:
  • Phone: 909-236-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MICHAEL CONSOLO
Title or Position: PHYSICIAN/SECRETARY
Credential: DO
Phone: 626-215-4524