Healthcare Provider Details

I. General information

NPI: 1588103683
Provider Name (Legal Business Name): NEPHROPHILES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2017
Last Update Date: 02/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2904 RODEO PARK DR E STE 300
SANTA FE NM
87505-6305
US

IV. Provider business mailing address

2904 RODEO PARK DR E STE 300
SANTA FE NM
87505-6305
US

V. Phone/Fax

Practice location:
  • Phone: 505-216-3466
  • Fax:
Mailing address:
  • Phone: 505-216-3466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD 2007-0093
License Number StateNM

VIII. Authorized Official

Name: CHARNES SY CHIU
Title or Position: PARTNER
Credential: MD
Phone: 505-216-3466