Antelope Valley Impotence & Incontinence Medical Center, Inc

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

C042345 Issued in CA

Legal business name

ANTELOPE VALLEY IMPOTENCE & INCONTINENCE MEDICAL CENTER, INC

Practice address

38921 Trade Center Dr
Palmdale, CA 93551-3652

Phone

(661) 945-0601

Fax

(833) 974-2391

NPI assigned

Sep 14, 2006

Last updated

Jan 31, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Eugene Clement Rajaratnain, MD FACS

Title

Ceo/Urologist

Phone

(661) 945-0601

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Eugene C Rajaratnam, M.D.

  • Urology Physician
  • Palmdale, CA
  • NPI 1386739027
  Medicare reassignment NPD
• Laura Galeazzi, A.C.N.P.

  • Acute Care Nurse Practitioner
  • Lancaster, CA
  • NPI 1982006748
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738281600000",
    "number": "1043315120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38921 TRADE CENTER DR",
            "city": "PALMDALE",
            "state": "CA",
            "postal_code": "935513652",
            "telephone_number": "661-945-0601",
            "fax_number": "833-974-2391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38921 TRADE CENTER DR",
            "city": "PALMDALE",
            "state": "CA",
            "postal_code": "935513652",
            "telephone_number": "661-945-0601",
            "fax_number": "833-974-2391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTELOPE VALLEY IMPOTENCE & INCONTINENCE MEDICAL CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "last_updated": "2025-01-31",
        "certification_date": "2025-01-31",
        "status": "A",
        "authorized_official_last_name": "RAJARATNAIN",
        "authorized_official_first_name": "EUGENE",
        "authorized_official_middle_name": "CLEMENT",
        "authorized_official_title_or_position": "CEO/UROLOGIST",
        "authorized_official_telephone_number": "661-945-0601",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD FACS"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "CA",
            "license": "C042345",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OOC423450",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Antelope Valley Community Clinic (Antelope Valley Community Clinic-Palmdale)
• Antelope Valley Community Clinic
• Antelope Valley Family Optometry, Inc (Antelope Valley Family Optometry)
• Antelope Valley Home Health Agency Inc.
• Antelope Valley Hospital OB Clinic Palmdale
• Antelope Valley Lung & Sleep Institute, Inc
• Antelope Valley Outpatient Imaging Center, LLC
• Antelope Valley Outpatient Imaging Center, LLC
• Antelope Valley Specialty Surgical Center, LLC
• Antelope Valley Summit Medical Group, Inc (Summit Urgent Care)

• Urology Physician in Palmdale, CA
• Providers in Palmdale, CA by specialty
• Urology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.