Healthcare Provider Details

I. General information

NPI: 1487993176
Provider Name (Legal Business Name): KIDNEY AND HYPERTENSION CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2013
Last Update Date: 01/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18546 ROSCOE BLVD STE 110
NORTHRIDGE CA
91324-4667
US

IV. Provider business mailing address

18546 ROSCOE BLVD STE 110
NORTHRIDGE CA
91324-4667
US

V. Phone/Fax

Practice location:
  • Phone: 818-993-5600
  • Fax: 818-775-1509
Mailing address:
  • Phone: 818-993-5600
  • Fax: 818-775-1509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA88861
License Number StateCA

VIII. Authorized Official

Name: DR. RAMANATH DUKKIPATI
Title or Position: PRESIDENT
Credential: M.D
Phone: 818-993-5600