Healthcare Provider Details

I. General information

NPI: 1518033513
Provider Name (Legal Business Name): UROLOGICAL ASSOC MEDICAL GRP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 10/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3637 CALIFORNIA STREET
SAN FRANCISCO CA
94118
US

IV. Provider business mailing address

3637 CALIFORNIA STREET
SAN FRANCISCO CA
94118
US

V. Phone/Fax

Practice location:
  • Phone: 415-752-7100
  • Fax: 415-752-1451
Mailing address:
  • Phone: 415-752-7100
  • Fax: 415-752-1451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberA28777
License Number StateCA

VIII. Authorized Official

Name: MRS. MARION COOPER
Title or Position: ACCOUNT MANAGER
Credential:
Phone: 415-609-8513