Provider Demographics
NPI:1194966309
Name:ADVANCED UROLOGY OF EL PASO, P.A
Entity type:Organization
Organization Name:ADVANCED UROLOGY OF EL PASO, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURICIO
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVALOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-909-6565
Mailing Address - Street 1:10301 GATEWAY BLVD W
Mailing Address - Street 2:SUITE 300
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10301 GATEWAY BLVD W
Practice Address - Street 2:SUITE 300
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-3315
Practice Address - Country:US
Practice Address - Phone:915-779-1716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN1606OtherMEDICAL LICENSE