Organization
CITRUS VALLEY UROLOGIC MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JOSEPHINE MARIE DAVIS R.N. (OFFICE MANAGER)
(626) 914-3921
Entity
Organization
Contact information
Practice address
412 WEST CARROLL AVENUE, SUITE 200, GLENDORA, CA 91741-4264
(626) 914-3921
(626) 914-9611
Mailing address
412 WEST CARROLL AVENUE, SUITE 200, GLENDORA, CA 91741-4264
(626) 914-3921
(626) 914-9611
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
CA
208800000X
Urology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZZ726372
—
CA
Enumeration date
05/10/2006
Last updated
03/27/2013
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