Basic Information
| Provider Information | |||||||||
| NPI: | 1972730315 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOSTER UROLOGY CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 370 DEL NORTE AVE | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | YUBA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959914142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5307514730 | ||||||||
| FaxNumber: | 5307514793 | ||||||||
| Practice Location | |||||||||
| Address1: | 370 DEL NORTE AVE | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | YUBA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959914142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5307514730 | ||||||||
| FaxNumber: | 5307514793 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2009 | ||||||||
| LastUpdateDate: | 06/12/2009 | ||||||||
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| AuthorizedOfficialLastName: | FOSTER | ||||||||
| AuthorizedOfficialFirstName: | LIONEL | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5307514730 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | G60284 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.