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General NPI Number Information
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NPI Number | 1205409752
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Entity Type | Organization
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Legal Business Name | FLORIDA KIDNEY PHYSICIANS, LLC
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Dates
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Enumeration Date | 07/22/2021
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Last Update Date | 07/22/2021
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Provider Practice Location Address
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Address Line | 3221 TAMIAMI TRL
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-8002
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Country | US
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Telephone | 941-505-8720
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Fax | 855-793-3651
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Provider Business Mailing Address
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Address Line | 3221 TAMIAMI TRL
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-8002
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Country | US
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Telephone | 941-505-8720
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Fax | 855-793-3651
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | MARIA ELENA RIVERA
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Credential |
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Telephone | 480-610-6100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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