Antelope Valley Urology Medical Group Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

A39485 Issued in CA

Legal business name

ANTELOPE VALLEY UROLOGY MEDICAL GROUP INC

Practice address

44105 15TH St W
Suite 302
Lancaster, CA 93534-4088

Phone

(661) 949-3006

Fax

(661) 949-8770

NPI assigned

Feb 14, 2007

Organization subpart

No

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

Authorized official

Name

Tawfik Tim Hadaya, M.D.

Title

President

Phone

(661) 949-3006

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

Practitioners 2

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

• Katherine Lee Schwegel, NP

  • Nurse Practitioner
  • Lancaster, CA
  • NPI 1316958341
  NPD (past)
• David Powell, MD

  • Anesthesiology Physician
  • Lakewood, CO
  • NPI 1639271240
  NPD (past)

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1396888152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44105 15TH ST W",
            "address_2": "SUITE 302",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935344088",
            "telephone_number": "661-949-3006",
            "fax_number": "661-949-8770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44105 15TH ST W",
            "address_2": "SUITE 302",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935344088",
            "telephone_number": "661-949-3006",
            "fax_number": "661-949-8770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTELOPE VALLEY UROLOGY MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HADAYA",
        "authorized_official_first_name": "TAWFIK",
        "authorized_official_middle_name": "TIM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "661-949-3006",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A39485",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "C39635",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0076830",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ53170Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Antelope Valley Surgery Center LP
• Antelope Valley Surgical Associates
• Antelope Valley Surgical Institute, LLC
• Antelope Valley Transit Authority
• Antelope Valley Union High School District
• Tonya Melynn Anthony, LCSW
• Marian Antona
• Antony C Ernest MD Inc Arun N Mehta MD Prof Corp Et Al PTR Valley Card
• Imani Antwine
• Jocelyn Aparicio

• Specialist in Lancaster, CA
• Providers in Lancaster, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.