Provider Demographics
NPI:1124563515
Name:ON CALL UROLOGY ASSOCIATES
Entity Type:Organization
Organization Name:ON CALL UROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:BIDAIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-229-2626
Mailing Address - Street 1:8851 CENTER DR STE 208
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3189
Mailing Address - Country:US
Mailing Address - Phone:619-229-2626
Mailing Address - Fax:619-286-5412
Practice Address - Street 1:8851 CENTER DR STE 208
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3189
Practice Address - Country:US
Practice Address - Phone:619-229-2626
Practice Address - Fax:619-286-5412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPENDINGOtherALL PENDING