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GREATER LONG BEACH GENITO-URINARY MED GRP NPI 1417976705


NPI Information

NPI: 1417976705
Provider Name: GREATER LONG BEACH GENITO-URINARY MED GRP
Classification: Urology - 208800000X
Entity Type: Organization
Address:
3650 SOUTH STREET
SUITE 408
LAKEWOOD, CA
ZIP 90712
Phone: (562) 630-0423
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GREATER LONG BEACH GENITO-URINARY MED GRP is an urology in Lakewood, 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. GREATER LONG BEACH GENITO-URINARY MED GRP NPI is 1417976705. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3650 SOUTH STREET
SUITE 408
LAKEWOOD, CA
ZIP 90712-510
Phone: (562) 630-0423
Fax: (562) 630-0660

The provider's authorized official is Jules M Perley .
The authorized official title is Md/president and has the following contact phone number (562) 630-0423.

The enumeration date for this NPI number is 7/18/2006 and was last updated on 1/15/2010.


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
1208800000XUrologyG22223CALIFORNIAYes

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
11801865381OTHERCALIFORNIAPHYSICIAN INDIVIDUAL PIN
2WA76527BOTHERCALIFORNIAMEDICARE INDIVIDUAL PROVI
3G54806OTHERCALIFORNIASTATE LICENSE
4W8676EMEDICARE ID-TYPE UNSPECIFIEDCALIFORNIAMEDICARE GROUP PROVIDER #
5W8676MEDICARE ID-TYPE UNSPECIFIEDCALIFORNIAMEDICARE GROUP PROVIDER #
6GR0049180MEDICAIDCALIFORNIA
7WA76527AOTHERCALIFORNIAMEDICARE INDIVIDUAL PROVI
8A76527OTHERCALIFORNIASTATE LICENSE
9G22223OTHERCALIFORNIASTATE LICENSE
10A52795MEDICARE UPINCALIFORNIA
11WG54806DOTHERCALIFORNIAMEDICARE INDIVIDUAL PROVI
121326017831OTHERCALIFORNIAPHYSICIAN INDIVIDUAL UPIN
13WG54806COTHERCALIFORNIAMEDICARE INDIVIDUAL PROVI
14WG22223AOTHERCALIFORNIAMEDICARE INDIVIDUAL PROVI
15WG22223BOTHERCALIFORNIAMEDICARE INDIVIDUAL PROVI
16A41515MEDICARE UPINCALIFORNIA
17W8676AMEDICARE ID-TYPE UNSPECIFIEDCALIFORNIAMEDICARE GROUP PROVIDER #
181497724900OTHERCALIFORNIAPHYSICIAN INDIVIDUAL PIN
19H52054MEDICARE UPINCALIFORNIA

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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