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General NPI Number Information
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NPI Number | 1730136573
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Entity Type | Organization
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Legal Business Name | SKYLINE UROLOGY
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 09/20/2021
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Provider Practice Location Address
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Address Line | 23456 HAWTHORNE BLVD, BUILDING 5 SUITE 260
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City | TORRANCE
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State | CA
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Zip | 90505
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Country | US
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Telephone | 310-602-5005
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Fax | 310-373-7895
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Provider Business Mailing Address
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Address Line | 23456 HAWTHORNE BLVD STE 260, BUILDING #5
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City | TORRANCE
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State | CA
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Zip | 90505-6658
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Country | US
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Telephone | 310-602-5005
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Fax | 310-373-7895
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Authorized Official
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Title or Position | DISPENSARY MANAGER
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Name | KEVIN BLASINGAME
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Credential | BSN, RN
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Telephone | 858-888-7700
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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 | FNP38252
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License Number State | CA
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