Provider Demographics
NPI:1841202074
Name:ASSOCIATES IN UROLOGY A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ASSOCIATES IN UROLOGY A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGHDASSARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-598-6166
Mailing Address - Street 1:3791 KATELLA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2016
Mailing Address - Country:US
Mailing Address - Phone:562-598-6166
Mailing Address - Fax:562-799-8210
Practice Address - Street 1:3791 KATELLA AVE STE 200
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2016
Practice Address - Country:US
Practice Address - Phone:562-598-6166
Practice Address - Fax:562-799-8210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0048240Medicaid
CAW11394CMedicare PIN
CAW11394AMedicare PIN
CAW11394Medicare PIN
CAGR0048240Medicaid