| Mission Urology | |
|
4500 Brockton Ave Suite 301 Riverside CA 92501-4027 | |
| (951) 276-4505 | |
| (951) 276-4517 |
| Full Name | Mission Urology |
|---|---|
| Speciality | Urology |
| Location | 4500 Brockton Ave, Riverside, California |
| Authorized Official Name and Position | Jo-ann Mendoza (PRESIDENT) |
| Authorized Official Contact | 9512764505 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mission Urology Po Box 7270 Moreno Valley CA 92552-7270 Ph: (951) 656-1500 | Mission Urology 4500 Brockton Ave Suite 301 Riverside CA 92501-4027 Ph: (951) 276-4505 |
| NPI Number | 1063874337 |
|---|---|
| Provider Enumeration Date | 03/24/2016 |
| Last Update Date | 06/24/2019 |
| Medicare PECOS PAC ID | 2466751888 |
|---|---|
| Medicare Enrollment ID | O20160505001643 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063874337 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 208800000X | Urology | (* (Not Available)) | Primary |
| Provider Name | Sy Tsi |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1194743864 PECOS PAC ID: 9537058508 Enrollment ID: I20040315001332 |
| Provider Name | Ken Takesita |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1629243837 PECOS PAC ID: 0547338923 Enrollment ID: I20081013000329 |
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