Provider Demographics
NPI:1407900426
Name:VALLEY UROLOGIC MEDICAL GROUP INC
Entity Type:Organization
Organization Name:VALLEY UROLOGIC MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-346-1133
Mailing Address - Street 1:39000 BOB HOPE DR
Mailing Address - Street 2:SUITE P303
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270
Mailing Address - Country:US
Mailing Address - Phone:760-346-1133
Mailing Address - Fax:760-346-8857
Practice Address - Street 1:39000 BOB HOPE DR
Practice Address - Street 2:SUITE P303
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270
Practice Address - Country:US
Practice Address - Phone:760-346-1133
Practice Address - Fax:760-346-8857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ72030ZMedicaid
CAZZZ72030ZMedicare ID - Type Unspecified
CAZZZ72030ZMedicaid