=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043321128
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PALO ALTO NEPHROLOGY ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 750 WELCH RD SUITE 214
-----------------------------------------------------
City | PALO ALTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94304-1507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-328-8385
-----------------------------------------------------
Fax | 650-328-0286
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 750 WELCH RD SUITE 214
-----------------------------------------------------
City | PALO ALTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94304-1507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-328-8385
-----------------------------------------------------
Fax | 650-328-0286
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | TOBY I GOTTHEINES
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 650-328-8385
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------