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General NPI Number Information
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NPI Number | 1750604948
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Entity Type | Organization
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Legal Business Name | UROLOGY CENTER OF SO CALIF MEDICAL GROUP INC
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Dates
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Enumeration Date | 03/02/2010
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Last Update Date | 08/23/2013
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Provider Practice Location Address
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Address Line | 28078 BAXTER RD #314
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City | MURRIETA
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State | CA
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Zip | 92563-1402
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Country | US
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Telephone | 951-677-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 1820 FULLERTON AVE #260
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City | CORONA
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State | CA
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Zip | 92881-3160
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BRUCE HOUMAN
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Credential |
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Telephone | 951-735-2700
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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 |
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License Number State | CA
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