Provider Demographics
NPI:1437100864
Name:UROLOGICAL MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:UROLOGICAL MEDICAL ASSOCIATES
Other - Org Name:ADVANCED UROLOGY MEDICAL OFFICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-670-9119
Mailing Address - Street 1:8540 S SEPULVEDA BLVD
Mailing Address - Street 2:#911
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3807
Mailing Address - Country:US
Mailing Address - Phone:310-670-9119
Mailing Address - Fax:310-670-7275
Practice Address - Street 1:8540 S SEPULVEDA BLVD
Practice Address - Street 2:#911
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3807
Practice Address - Country:US
Practice Address - Phone:310-670-9119
Practice Address - Fax:310-670-7275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0028600Medicaid
CAGR0028600Medicaid
CAW10032Medicare PIN