Corvalan Urology Medical Center

Primary specialty

SpecialistTaxonomy code 174400000X

License

A25561 Issued in CA

Legal business name

CORVALAN UROLOGY MEDICAL CENTER

Practice address

800 Fairmount Ave Ste 420
Pasadena, CA 91105-3154

Phone

(818) 500-0417

Fax

(626) 440-9178

NPI assigned

Apr 3, 2007

Last updated

Aug 22, 2020By 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

Jaime Corvalan, MD

Title

President

Phone

(818) 500-0417

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1811018948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 FAIRMOUNT AVE STE 420",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911053154",
            "telephone_number": "818-500-0417",
            "fax_number": "626-440-9178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 FAIRMOUNT AVE STE 420",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911053154",
            "telephone_number": "818-500-0417",
            "fax_number": "626-440-9178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORVALAN UROLOGY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CORVALAN",
        "authorized_official_first_name": "JAIME",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-500-0417",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "A25561",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A255610",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ66096Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hoffman Ramon Cortes
• Jaime Cortes III
• Edna Cortez
• Mirna Cortez
• Myrna Cortez, MSW
• Cosimia Health Care Services, Inc.
• Cosmopolitan Home Care Services
• Jeremiah Cosmos-Jackson
• Ted Cosse, M.A.
• Liam Robert Costa

• Specialist in Pasadena, CA
• Providers in Pasadena, 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.