Organization
ATLANTIC UROLOGY MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WENDY SOLIS (OFFICE MANAGER)
(562) 595-5977
Entity
Organization
Contact information
Practice address
701 E 28TH ST, SUITE 319, LONG BEACH, CA 90806-2759
(562) 595-5977
(562) 490-0509
Mailing address
701 E 28TH ST, SUITE 319, LONG BEACH, CA 90806-2759
(562) 595-5977
(562) 490-0509
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A32052
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2405716
—
CA
01
—
W9927
MEDICARE ID
CA
Enumeration date
10/01/2007
Last updated
08/27/2019
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