Provider Demographics
NPI:1548376577
Name:UROLOGICAL MEDICAL GROUP OF NORTH ORANGE COUNTY
Entity type:Organization
Organization Name:UROLOGICAL MEDICAL GROUP OF NORTH ORANGE COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-870-5970
Mailing Address - Street 1:301 W BASTANCHURY RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835
Mailing Address - Country:US
Mailing Address - Phone:714-870-5970
Mailing Address - Fax:714-870-4752
Practice Address - Street 1:301 W BASTANCHURY RD
Practice Address - Street 2:SUITE 180
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835
Practice Address - Country:US
Practice Address - Phone:714-870-5970
Practice Address - Fax:714-870-4752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP2151OtherRR MEDICARE
W11198Medicare ID - Type Unspecified