Healthcare Provider Details

I. General information

NPI: 1679664643
Provider Name (Legal Business Name): MERCED TURLOCK NEPHROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3351 M ST 125
MERCED CA
95348
US

IV. Provider business mailing address

3351 M ST 125
MERCED CA
95348
US

V. Phone/Fax

Practice location:
  • Phone: 209-723-1020
  • Fax: 209-723-6784
Mailing address:
  • Phone: 209-723-1020
  • Fax: 209-723-6784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA42706
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. NIRMAL S AUJLA
Title or Position: DOCTOR
Credential: M.D.
Phone: 209-723-1020