Provider Demographics
NPI:1881715902
Name:SANTA CLARITA UROLOGY ASSOC INC
Entity type:Organization
Organization Name:SANTA CLARITA UROLOGY ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:B
Authorized Official - Last Name:SENDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-254-2777
Mailing Address - Street 1:23928 LYONS AVE
Mailing Address - Street 2:#202
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2409
Mailing Address - Country:US
Mailing Address - Phone:661-254-2777
Mailing Address - Fax:661-799-9788
Practice Address - Street 1:23928 LYONS AVE
Practice Address - Street 2:#202
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321
Practice Address - Country:US
Practice Address - Phone:661-254-2777
Practice Address - Fax:661-253-2837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG048510208800000X
CAG036408208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG36408ACAMedicare ID - Type Unspecified
A91777Medicare UPIN
A51084Medicare UPIN