ANTELOPE VALLEY IMPOTENCE & INCONTINENCE MEDICAL CENTER, INC (NPI# 1043315120) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043315120 |
| Entity Type | Organization |
| Organization Name | ANTELOPE VALLEY IMPOTENCE & INCONTINENCE MEDICAL CENTER, INC |
| Practice Address |
44241 North 15th Street West Suite 101 Lancaster CA 93534 |
| Practice Telephone | 6619450601 |
| Practice Fax Number | 6619495965 |
| Mailing Telephone | 6619450601 |
| Mailing Fax Number | 6619495965 |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. EUGENE CLEMENT RAJARATNAIN (CEO/UROLOGIST) |
| Authorized Official Telephone | 6619450601 |
| Authorized Official Credential | MD FACS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | C042345 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | OOC423450 | 05 |
| Street Address |
44241 NORTH 15TH STREET WEST SUITE 101 |
| City | LANCASTER |
| State | CA |
| Zip Code | 93534 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194346098 | Lori Ann Barlow Washington | Counselor | 921 W J Street, Lancaster, CA 93534 | 2020-05-01 |
| 1629698253 | Gisela Regalado Paredes | Surgery | Antelope Valley Hospital, 1600 West Ave J, Lancaster, CA 93534 | 2020-04-23 |
| 1124668470 | Latonya Jean Allen | Case Manager/Care Coordinator | 44443 10th St. West, Lancaster, CA 93534 | 2020-01-14 |
| 1629629746 | Korinna Fite | Occupational Therapy Assistant | 43860 10th St. W., Lancaster, CA 93534 | 2019-09-20 |
| 1114576105 | Victor Nemr Hass Md | Anesthesiology | Embassy Surgery Center, 42135 10th Street West 325, Lancaster, CA 93534 | 2019-09-11 |
| 1609421007 | Jaime A Mort | Nurse Practitioner | 43112 N 15st W, Lancaster, CA 93534 | 2019-08-03 |
| 1013560747 | Allyson Lods | Dietitian, Registered | 43115 15th Street West, Lancaster, CA 93534 | 2019-07-22 |
| 1144884123 | Nicole Breanne Palman | Speech-Language Pathologist | 43860 10th St. West, 1st Floor, Lancaster, CA 93534 | 2019-04-25 |
| 1841761475 | Vanessa Gonzalez | Case Manager/Care Coordinator | 44226 10th St West, Lancaster, CA 93534 | 2018-12-07 |
| 1760969265 | Marilyn Joy Pollack | Physical Therapy Assistant | 1306 W Avenue J Ste 2, Lancaster, CA 93534 | 2018-07-26 |
| Find all providers in zip 93534 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| 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. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356748099 | Jon Gilchrist Walker | Urology | 110 N Duke St, Apt 301, Lancaster, PA 17602-2804 | 2014-11-24 |
| 1013321173 | Marvin Clifford Daley | Urology | 31 Deer Ford Dr, Lancaster, PA 17601-5642 | 2014-06-17 |
| 1669896361 | Joseph Aloysius Breslin Jr. | Urology | 1280 Wheatland Ave, Lancaster, PA 17603-4750 | 2014-02-15 |
| 1144589359 | High Desert Urology Medical Group, Inc | Urology | 44105 15th St W Ste 302, Lancaster, CA 93534-4089 | 2012-05-08 |
| 1740441583 | Charles Edward Pohl | Urology | 605 Hamilton Rd, Lancaster, PA 17603-2409 | 2008-06-24 |
| 1194929463 | Derrick Lamar Reedus Sr. | Urology | 135 N Ewing St Ste 201, Lancaster, OH 43130 | 2007-06-12 |
| 1851427926 | Urological Specialists, Ltd | Urology | 1655 B Crooked Oak Drive, Lancaster, PA 17601 | 2007-02-26 |
| 1295758555 | Lancaster County Urological Associates | Urology | 600 Eden Rd # F, Lancaster, PA 17601-4205 | 2006-07-26 |
| 1336164227 | Carolina Urology Center, Pa | Urology | 1077 W Meeting St, Suite A, Lancaster, SC 29720-2205 | 2006-07-13 |
| 1346292109 | Jeffrey Lee Rosenblum | Urology | 2221 Noll Dr Ste 1000, Lancaster, PA 17603-7610 | 2006-05-17 |
| Find all providers in LANCASTER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.