Healthcare Provider Details

I. General information

NPI: 1023398989
Provider Name (Legal Business Name): VICTORIA NEPHROLOGY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 HOSPITAL DR STE 114
VICTORIA TX
77901-5743
US

IV. Provider business mailing address

2710 HOSPITAL DR STE 114
VICTORIA TX
77901-5743
US

V. Phone/Fax

Practice location:
  • Phone: 361-582-7999
  • Fax: 361-582-7998
Mailing address:
  • Phone: 361-582-7999
  • Fax: 361-582-7998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberN1373
License Number StateTX

VIII. Authorized Official

Name: HARESH KUMAR
Title or Position: MD
Credential: M.D.
Phone: 361-582-7999