Healthcare Provider Details

I. General information

NPI: 1568424679
Provider Name (Legal Business Name): NEPHROLOGY SPECIALISTS MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 W LA VETA AVE STE 107
ORANGE CA
92868
US

IV. Provider business mailing address

705 W LA VETA AVE STE 107
ORANGE CA
92868-4447
US

V. Phone/Fax

Practice location:
  • Phone: 714-639-4901
  • Fax: 714-771-5389
Mailing address:
  • Phone: 714-693-7901
  • Fax: 714-771-5389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AMER JABARA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-639-4901