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General NPI Number Information
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NPI Number | 1083649651
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Entity Type | Organization
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Legal Business Name | L A COUNTY NEPHROLOGY ASSOCIATES A MEDICAL CORPORATION
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 06/26/2024
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Provider Practice Location Address
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Address Line | 3114 W BEVERLY BLVD
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City | MONTEBELLO
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State | CA
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Zip | 90640-2217
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Country | US
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Telephone | 323-726-1317
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Fax | 323-726-3870
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Provider Business Mailing Address
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Address Line | PO BOX 22036
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City | BELFAST
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State | ME
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Zip | 04915-4117
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Country | US
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Telephone | 323-726-3868
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Fax | 323-726-3870
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. SANDY MARINO
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Credential |
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Telephone | 323-726-3868
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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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