Healthcare Provider Details

I. General information

NPI: 1497948491
Provider Name (Legal Business Name): SAN ANTONIO UROLOGY MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 03/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 E ARROW HWY SUITE E
UPLAND CA
91786-5525
US

IV. Provider business mailing address

1175 E ARROW HWY SUITE E
UPLAND CA
91786-5525
US

V. Phone/Fax

Practice location:
  • Phone: 909-985-9737
  • Fax: 909-981-1203
Mailing address:
  • Phone: 909-985-9737
  • Fax: 909-981-1203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOHN U ALVAREZ
Title or Position: BILLING MANAGER
Credential:
Phone: 909-949-8866