Basic Information
| Provider Information | |||||||||
| NPI: | 1881715902 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SANTA CLARITA UROLOGY ASSOC INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23928 LYONS AVE | ||||||||
| Address2: | #202 | ||||||||
| City: | NEWHALL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913212409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612542777 | ||||||||
| FaxNumber: | 6617999788 | ||||||||
| Practice Location | |||||||||
| Address1: | 23928 LYONS AVE | ||||||||
| Address2: | #202 | ||||||||
| City: | NEWHALL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612542777 | ||||||||
| FaxNumber: | 6612532837 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 10/14/2010 | ||||||||
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| AuthorizedOfficialLastName: | SENDER | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | PRES | ||||||||
| AuthorizedOfficialTelephone: | 6612542777 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | G048510 | CA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology | 208800000X | G036408 | CA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.