Individual
SY TSI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
801 S. MAIN ST., SUITE 201, CORONA, CA 92882
(951) 735-2700
(951) 256-8255
Mailing address
801 S. MAIN ST., SUITE 201, CORONA, CA 92882
(951) 735-2700
(951) 256-8255
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
A74951
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A749510
—
CA
Enumeration date
07/18/2006
Last updated
09/24/2018
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