Provider Demographics
NPI:1881225050
Name:LA COSTA UROLOGY , INC
Entity Type:Organization
Organization Name:LA COSTA UROLOGY , INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-916-6946
Mailing Address - Street 1:3907 WARING RD STE 4
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4454
Mailing Address - Country:US
Mailing Address - Phone:760-940-5012
Mailing Address - Fax:760-940-4095
Practice Address - Street 1:3907 WARING RD STE 4
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4454
Practice Address - Country:US
Practice Address - Phone:760-295-9984
Practice Address - Fax:760-295-9987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-28
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty