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Organization

FOOTHILL UROLOGY ASSOCIATES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. TINA M. SOTO (OFFICE MANAGER)
(626) 795-8454
Entity
Organization

Contact information

Practice address
630 S RAYMOND AVE, SUITE 220, PASADENA, CA 91105-3278
(626) 795-8454
(626) 795-5631
Mailing address
630 S RAYMOND AVE, SUITE 220, PASADENA, CA 91105-3278
(626) 795-8454
(626) 795-5631

Taxonomy

Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
CN2645
MEDICARE RR
CA
01
ZZZ33990Z
BLUE SHIELD
CA
Enumeration date
01/03/2007
Last updated
03/14/2008
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