Organization
VALLEY ASSOCIATED UROLOGY MEDICARE GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GERALD BOYAJIAN (CHIEF ADMINISTRATIVE OFFICER)
(209) 521-0870
Entity
Organization
Contact information
Practice address
200 COTTAGE AVE, STE 101, MANTECA, CA 95336-4935
(209) 239-2197
(209) 239-7672
Mailing address
1541 FLORIDA AVE, STE 306, MODESTO, CA 95350-4429
(209) 521-0870
(209) 521-0398
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0066264
—
CA
Enumeration date
06/19/2006
Last updated
09/13/2007
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