Healthcare Provider Details

I. General information

NPI: 1083649651
Provider Name (Legal Business Name): L A COUNTY NEPHROLOGY ASSOCIATES A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3114 W BEVERLY BLVD
MONTEBELLO CA
90640-2217
US

IV. Provider business mailing address

PO BOX 22036
BELFAST ME
04915-4117
US

V. Phone/Fax

Practice location:
  • Phone: 323-726-1317
  • Fax: 323-726-3870
Mailing address:
  • Phone: 323-726-3868
  • Fax: 323-726-3870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MS. SANDY MARINO
Title or Position: OFFICE MANAGER
Credential:
Phone: 323-726-3868