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General NPI Number Information
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NPI Number | 1528154507
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Entity Type | Organization
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Legal Business Name | MENDEZ TRANSPLANT AND UROLOGICAL MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 05/22/2019
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Provider Practice Location Address
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Address Line | 1401 S GRAND AVE
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City | LOS ANGELES
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State | CA
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Zip | 90015-3010
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Country | US
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Telephone | 213-802-0100
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Fax | 626-795-3229
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Provider Business Mailing Address
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Address Line | PO BOX 1004
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City | SIERRA MADRE
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State | CA
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Zip | 91025-4004
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Country | US
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Telephone | 213-802-0100
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Fax | 626-795-3229
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. THOMAS PAUL BOGAARD
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Credential | M.D.
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Telephone | 213-802-0100
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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 |
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License Number State |
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