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General NPI Number Information
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NPI Number | 1720316318
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Entity Type | Organization
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Legal Business Name | INSTITUTE OF UROLOGY, LLC
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Dates
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Enumeration Date | 11/19/2009
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Last Update Date | 09/20/2013
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Provider Practice Location Address
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Address Line | 5300 S HIGHWAY 95 SUITE K
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City | FORT MOHAVE
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State | AZ
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Zip | 86426-9251
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Country | US
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Telephone | 928-768-6800
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 33660
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City | LAUGHLIN
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State | NV
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Zip | 89028-3660
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Country | US
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Telephone | 928-768-6800
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. ARNALDO FRANCESCO TRABUCCO
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Credential | M.D.
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Telephone | 928-768-6800
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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 | 42374
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License Number State | AZ
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