Provider Demographics
NPI:1386156842
Name:ORANGE COUNTY UROLOGY ASSOCIATES INC. A MEDICAL GROUP
Entity type:Organization
Organization Name:ORANGE COUNTY UROLOGY ASSOCIATES INC. A MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-855-1101
Mailing Address - Street 1:25200 LA PAZ RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5134
Mailing Address - Country:US
Mailing Address - Phone:949-855-1101
Mailing Address - Fax:
Practice Address - Street 1:16305 SAND CANYON AVE STE 200
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3783
Practice Address - Country:US
Practice Address - Phone:949-855-1101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORANGE COUNTY UROLOGY ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty