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General NPI Number Information
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NPI Number | 1366550675
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Entity Type | Organization
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Legal Business Name | CENTRAL COAST NEPHROLOGY MEDICAL CORPORATION
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Dates
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Enumeration Date | 08/27/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 917 BLANCO CIRCLE
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City | SALINAS
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State | CA
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Zip | 93901-4446
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Country | US
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Telephone | 831-755-7999
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Fax | 831-755-7975
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Provider Business Mailing Address
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Address Line | 917 BLANCO CIRCLE
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City | SALINAS
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State | CA
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Zip | 93901-4446
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Country | US
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Telephone | 831-755-7999
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Fax | 831-755-7975
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. BARBARA LOIS REVER
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Credential | MD
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Telephone | 831-755-7999
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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 | G308710
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | G507670
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | A66902
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | A767040
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | A116032
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License Number State | CA
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Taxonomy #6
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | A36123
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License Number State | CA
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