Provider Demographics
NPI:1275633695
Name:SIMI SAN FERNANDO VALLEY UROLOGY ASSOCIATES
Entity Type:Organization
Organization Name:SIMI SAN FERNANDO VALLEY UROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MUNI
Authorized Official - Middle Name:NANJUNDA
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-365-0259
Mailing Address - Street 1:14901 RINALDI ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1204
Mailing Address - Country:US
Mailing Address - Phone:818-365-0259
Mailing Address - Fax:805-365-0827
Practice Address - Street 1:14901 RINALDI ST
Practice Address - Street 2:SUITE 205
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1204
Practice Address - Country:US
Practice Address - Phone:818-365-0259
Practice Address - Fax:805-365-0827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37982174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A379820Medicaid
CAA28500Medicare UPIN
CA00A379820Medicaid
CAW7935AMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER