Basic Information
| Provider Information | |||||||||
| NPI: | 1831122480 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PACIFIC UROLOGY A MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2222 EAST STREET | ||||||||
| Address2: | #250 | ||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9256097220 | ||||||||
| FaxNumber: | 9256893298 | ||||||||
| Practice Location | |||||||||
| Address1: | 2222 EAST STREET | ||||||||
| Address2: | #250 | ||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9256097220 | ||||||||
| FaxNumber: | 9256893298 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | TAYLOR | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | PAUL | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9256097220 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.