Provider Demographics
NPI:1184724502
Name:SIMI SAN FERNANDO VALLEY UROLOGY ASSOCIATES
Entity type:Organization
Organization Name:SIMI SAN FERNANDO VALLEY UROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MUNI
Authorized Official - Middle Name:NANJUNDA
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-373-8611
Mailing Address - Street 1:2100 LYNN RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1935
Mailing Address - Country:US
Mailing Address - Phone:805-373-8611
Mailing Address - Fax:805-373-2857
Practice Address - Street 1:2190 LYNN RD
Practice Address - Street 2:SUITE 290
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1980
Practice Address - Country:US
Practice Address - Phone:805-373-8611
Practice Address - Fax:805-373-2857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37982174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA096608547OtherSS#
CA00A379820Medicaid
CAA28500Medicare UPIN
CAW7935Medicare ID - Type UnspecifiedMEDICAR GROUP ID NUMBER