Healthcare Provider Details

I. General information

NPI: 1023085271
Provider Name (Legal Business Name): SIMI SAN FERNANDO VALLEY UROLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 01/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 SYCAMORE DR SUITE 103
SIMI VALLEY CA
93065-1207
US

IV. Provider business mailing address

2925 SYCAMORE DR SUITE 103
SIMI VALLEY CA
93065-1207
US

V. Phone/Fax

Practice location:
  • Phone: 805-583-0944
  • Fax: 805-526-0417
Mailing address:
  • Phone: 805-583-0944
  • Fax: 805-526-0417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA37982
License Number StateCA

VIII. Authorized Official

Name: DR. MUNI NANJUNDA REDDY
Title or Position: SR. PARTNER
Credential: MD
Phone: 805-583-0944