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General NPI Number Information
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NPI Number | 1194734731
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Entity Type | Organization
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Legal Business Name | DIABLO NEPHROLOGY MEDICAL GROUP, INC
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 09/15/2015
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Provider Practice Location Address
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Address Line | 2222 EAST STREET STE 305
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City | CONCORD
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State | CA
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Zip | 94520-2066
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Country | US
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Telephone | 925-686-1230
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Fax | 925-686-8443
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Provider Business Mailing Address
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Address Line | 2222 EAST STREET STE 305
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City | CONCORD
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State | CA
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Zip | 94520-2066
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Country | US
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Telephone | 925-686-1230
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Fax | 925-686-8443
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | FAWN HUTTON
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Credential | MBA
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Telephone | 925-686-0315
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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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