Organization
TRINITY UROLOGICAL & SURGICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALEX YACOUB (BILLING OFFICE MANAGER)
(323) 720-9204
Entity
Organization
Contact information
Practice address
126 S MONTEBELLO BLVD, MONTEBELLO, CA 90640-4730
(323) 720-9204
(323) 720-9208
Mailing address
126 S MONTEBELLO BLVD, MONTEBELLO, CA 90640-4730
(323) 720-9204
(323) 720-9208
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
A40189
CA
208D00000X
General Practice Physician
A40189
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0070010
—
CA
05
—
GR0070630
—
CA
Enumeration date
02/20/2007
Last updated
02/14/2020
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