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
Update your record
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