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General NPI Number Information
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NPI Number | 1003948340
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Entity Type | Organization
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Legal Business Name | VALLEY NEPHROLOGY ASSOCIATES
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 03/03/2010
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Provider Practice Location Address
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Address Line | 608 E ORANGEBURG AVE
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City | MODESTO
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State | CA
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Zip | 95350-5513
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Country | US
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Telephone | 209-529-2645
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Fax | 209-529-3024
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Provider Business Mailing Address
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Address Line | 608 E ORANGEBURG AVE
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City | MODESTO
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State | CA
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Zip | 95350-5513
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Country | US
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Telephone | 209-529-2645
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Fax | 209-529-3024
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSE M.R. SANTOS
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Credential | MD
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Telephone | 209-529-2645
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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