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ANTELOPE VALLEY IMPOTENCE & INCONTINENCE MEDICAL CENTER INC NPI 1043315120


NPI Information

NPI: 1043315120
Provider Name: ANTELOPE VALLEY IMPOTENCE & INCONTINENCE MEDICAL CENTER, INC
Classification: Urology - 208800000X
Entity Type: Organization

CLIA Number: 05D0869051

Address:
44241 NORTH 15TH STREET WEST
SUITE 101
LANCASTER, CA
ZIP 93534
Phone: (661) 945-0601
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ANTELOPE VALLEY IMPOTENCE & INCONTINENCE MEDICAL CENTER, INC is an urology in Lancaster, CA. The provider is a urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. ANTELOPE VALLEY IMPOTENCE & INCONTINENCE MEDICAL CENTER, INC NPI is 1043315120. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

44241 NORTH 15TH STREET WEST
SUITE 101
LANCASTER, CA
ZIP 93534
Phone: (661) 945-0601
Fax: (661) 949-5965

The provider's authorized official is Eugene Clement Rajaratnain .
The authorized official title is Ceo/urologist and has the following contact phone number (661) 945-0601.

The CLIA number assigned to this NPI record is 05D0869051 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/14/2006 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208800000XUrologyC042345CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1OOC423450MEDICAIDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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