MEDICARE: SIMI SAN FERNANDO VALLEY UROLOGY ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	A37982	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	096608547	OTHER	CA	SS#
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184724502
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMI SAN FERNANDO VALLEY UROLOGY ASSOCIATES

Provider Business Mailing Address
First Line	:	2100 LYNN RD
Second Line	:	SUITE 250
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91360-1935
Country	:	US
Telephone Number	:	805-373-8611
Fax Number	:	805-373-2857

Provider Business Practice Location Address
First Line	:	2190 LYNN RD
Second Line	:	SUITE 290
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91360-1980
Country	:	US
Telephone Number	:	805-373-8611
Fax Number	:	805-373-2857

Authorized Official
Title or Position	:	SR. PARTNER
Name	:	DR. MUNI NANJUNDA REDDY
Credential	:	MD
Telephone Number	:	805-373-8611

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	06/04/2010

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