Provider Demographics
NPI:1174773774
Name:NORCAL UROLOGY MEDICAL GROUP
Entity type:Organization
Organization Name:NORCAL UROLOGY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:F
Authorized Official - Last Name:DEVIVO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-465-5800
Mailing Address - Street 1:3300 WEBSTER ST
Mailing Address - Street 2:SUITE 710
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609
Mailing Address - Country:US
Mailing Address - Phone:510-465-5800
Mailing Address - Fax:510-839-8984
Practice Address - Street 1:2700 GRANT ST
Practice Address - Street 2:SUITE 316
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2266
Practice Address - Country:US
Practice Address - Phone:925-825-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty