Organization
HIGH DESERT UROLOGY MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TAWFIK T HADAYA M.D. (PRESIDENT)
(661) 949-3006
Entity
Organization
Contact information
Practice address
44105 15TH ST W STE 302, LANCASTER, CA 93534-4089
(661) 949-3006
(661) 949-8770
Mailing address
44105 15TH ST W STE 302, LANCASTER, CA 93534-4089
(661) 949-3006
(661) 949-8770
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
A39485
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0308929
—
CA
Enumeration date
05/08/2012
Last updated
07/10/2012
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