Organization
EASTERN SIERRA UROLOGY PROF CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TOMI L BORTOLAZZO M.D. (OWNER)
(760) 872-1606
Entity
Organization
Contact information
Practice address
152 PIONEER LN, SUITE F, BISHOP, CA 93514-2563
(760) 872-1606
(760) 872-3463
Mailing address
152 PIONEER LN, SUITE F, BISHOP, CA 93514-2563
(760) 872-1606
(760) 872-3463
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
G67284
CA
Other
Enumeration date
04/16/2007
Last updated
12/14/2010
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