Healthcare Provider Details

I. General information

NPI: 1790962900
Provider Name (Legal Business Name): NEPHROLOGY CONSULTANTS MEDICAL OFFICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S MAIN ST STE 101
ORANGE CA
92868-4507
US

IV. Provider business mailing address

500 S MAIN ST STE 101
ORANGE CA
92868-4507
US

V. Phone/Fax

Practice location:
  • Phone: 714-836-4204
  • Fax: 714-836-1809
Mailing address:
  • Phone: 714-836-4204
  • Fax: 714-836-1809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL EDWARD ARQUILLA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-836-4204