Organization
CORVALAN UROLOGY MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAIME CORVALAN MD (PRESIDENT)
(818) 500-0417
Entity
Organization
Contact information
Practice address
800 FAIRMOUNT AVE STE 420, PASADENA, CA 91105-3154
(818) 500-0417
(626) 440-9178
Mailing address
800 FAIRMOUNT AVE STE 420, PASADENA, CA 91105-3154
(818) 500-0417
(626) 440-9178
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A25561
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A255610
—
CA
01
—
ZZZ66096Z
BLUE SHIELD
CA
Enumeration date
04/03/2007
Last updated
08/22/2020
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