NPIMap

Organization Active NPI

Citrus Valley Urologic Medical Group, Inc.

  • Urology Physician
  • Glendora, CA
National Provider Identifier
1366491888
Registry record updated Mar 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
CITRUS VALLEY UROLOGIC MEDICAL GROUP, INC.
Practice address
412 West Carroll Avenue
Suite 200
Glendora, CA 91741-4264
Phone
(626) 914-3921
Fax
(626) 914-9611
NPI assigned
May 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2013

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

Authorized official

Name
Mrs. Josephine Marie Davis, R.N.
Title
Office Manager
Phone
(626) 914-3921

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208800000X
Urology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208800000X CA Primary

Addresses

Primary practice location

412 West Carroll Avenue
Suite 200
Glendora, CA 91741-4264

Mailing address

412 West Carroll Avenue
Suite 200
Glendora, CA 91741-4264
Phone (626) 914-3921

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ726372MedicaidCA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364342400000",
    "number": "1366491888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 WEST CARROLL AVENUE",
            "address_2": "SUITE 200",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917414264",
            "telephone_number": "626-914-3921",
            "fax_number": "626-914-9611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 WEST CARROLL AVENUE",
            "address_2": "SUITE 200",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917414264",
            "telephone_number": "626-914-3921",
            "fax_number": "626-914-9611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITRUS VALLEY UROLOGIC MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2013-03-27",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "JOSEPHINE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "626-914-3921",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Urology",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ726372",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendora, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.