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General NPI Number Information
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NPI Number | 1184724502
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Entity Type | Organization
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Legal Business Name | SIMI SAN FERNANDO VALLEY UROLOGY ASSOCIATES
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 06/04/2010
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Provider Practice Location Address
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Address Line | 2190 LYNN RD SUITE 290
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-1980
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Country | US
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Telephone | 805-373-8611
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Fax | 805-373-2857
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Provider Business Mailing Address
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Address Line | 2100 LYNN RD SUITE 250
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-1935
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Country | US
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Telephone | 805-373-8611
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Fax | 805-373-2857
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Authorized Official
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Title or Position | SR. PARTNER
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Name | DR. MUNI NANJUNDA REDDY
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Credential | MD
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Telephone | 805-373-8611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A37982
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License Number State | CA
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