Provider Demographics
NPI:1427187418
Name:WEST COAST UROLOGIC ASSOCIATES
Entity Type:Organization
Organization Name:WEST COAST UROLOGIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-795-8454
Mailing Address - Street 1:630 S RAYMOND AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3278
Mailing Address - Country:US
Mailing Address - Phone:626-795-8454
Mailing Address - Fax:626-795-5631
Practice Address - Street 1:630 S RAYMOND AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3278
Practice Address - Country:US
Practice Address - Phone:626-795-8454
Practice Address - Fax:626-795-5631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty