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General NPI Number Information
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NPI Number | 1265758528
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Entity Type | Organization
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Legal Business Name | UROLOGY SPECIALISTS OF SAN DIEGO INC
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Dates
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Enumeration Date | 04/12/2010
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Last Update Date | 12/20/2011
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Provider Practice Location Address
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Address Line | 752 MEDICAL CENTER CT SUITE 302
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City | CHULA VISTA
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State | CA
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Zip | 91911-6658
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Country | US
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Telephone | 619-397-4500
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Fax | 619-397-4510
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Provider Business Mailing Address
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Address Line | PO BOX 33865
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City | SAN DIEGO
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State | CA
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Zip | 92163-3865
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Country | US
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Telephone | 858-888-7700
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Fax | 858-888-7721
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Authorized Official
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Title or Position | PRESIDENT
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Name | JULIAN N ANTHONY
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Credential | M.D.
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Telephone | 619-397-4500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | A82316
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License Number State | CA
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