Provider Demographics
NPI:1194720730
Name:UROLOGY ASSOCIATES OF CENTRAL CALIFORNIA, INC
Entity type:Organization
Organization Name:UROLOGY ASSOCIATES OF CENTRAL CALIFORNIA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:DALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-321-2898
Mailing Address - Street 1:7014 N WHITNEY AVE
Mailing Address - Street 2:STE B
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0155
Mailing Address - Country:US
Mailing Address - Phone:559-321-2898
Mailing Address - Fax:559-321-2026
Practice Address - Street 1:7014 N WHITNEY AVE
Practice Address - Street 2:STE B
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0155
Practice Address - Country:US
Practice Address - Phone:559-321-2898
Practice Address - Fax:559-321-2026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA040000484261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASUR01435FMedicaid
CAX37467Medicare UPIN
CAZZZ15932ZMedicare ID - Type Unspecified