| Trinity Urological & Surgical Group | |
|
126 S Montebello Blvd Montebello CA 90640-4730 | |
| (323) 720-9204 | |
| (323) 720-9208 |
| Full Name | Trinity Urological & Surgical Group |
|---|---|
| Speciality | Urology |
| Location | 126 S Montebello Blvd, Montebello, California |
| Authorized Official Name and Position | Alex Yacoub (BILLING OFFICE MANAGER) |
| Authorized Official Contact | 3237209204 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Trinity Urological & Surgical Group 126 S Montebello Blvd Montebello CA 90640-4730 Ph: (323) 720-9204 | Trinity Urological & Surgical Group 126 S Montebello Blvd Montebello CA 90640-4730 Ph: (323) 720-9204 |
| NPI Number | 1245374354 |
|---|---|
| Provider Enumeration Date | 02/20/2007 |
| Last Update Date | 02/14/2020 |
| Medicare PECOS PAC ID | 3577520501 |
|---|---|
| Medicare Enrollment ID | O20041211000042 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245374354 | NPI | - | NPPES |
| GR0070630 | Medicaid | CA | |
| GR0070010 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | A40189 (California) | Secondary |
| 208800000X | Urology | A40189 (California) | Primary |
| Provider Name | Atef L Yacoub |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1740339894 PECOS PAC ID: 9931166964 Enrollment ID: I20041211000050 |
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