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General NPI Number Information
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NPI Number | 1285883769
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Entity Type | Organization
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Legal Business Name | TRINITY UROLOGICAL AND SURGICAL, INC.
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Dates
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Enumeration Date | 09/09/2008
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Last Update Date | 09/09/2008
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Provider Practice Location Address
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Address Line | 101 E BEVERLY BLVD STE 300
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City | MONTEBELLO
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State | CA
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Zip | 90640-4316
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Country | US
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Telephone | 323-728-9300
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Fax | 323-728-0184
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Provider Business Mailing Address
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Address Line | 126 S MONTEBELLO BLVD
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City | MONTEBELLO
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State | CA
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Zip | 90640-4730
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Country | US
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Telephone | 323-720-9204
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Fax | 323-720-9208
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. ALEXANDER YACOUB
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Credential |
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Telephone | 323-720-9204
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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 | A40189
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License Number State | CA
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