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General NPI Number Information
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NPI Number | 1508196759
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Entity Type | Organization
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Legal Business Name | HIGH DESERT NEPHROLOGY MEDICAL ASSOCIATES, INC.
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Dates
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Enumeration Date | 01/12/2010
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Last Update Date | 02/23/2011
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Provider Practice Location Address
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Address Line | 655 S. 7TH AVE.
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City | BARSTOW
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State | CA
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Zip | 92311-3001
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Country | US
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Telephone | 760-256-3918
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Fax | 760-256-5217
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Provider Business Mailing Address
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Address Line | 12675 HESPERIA RD.
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City | VICTORVILLE
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State | CA
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Zip | 92395-5878
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Country | US
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Telephone | 760-241-3306
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Fax | 760-241-8063
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Authorized Official
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Title or Position | OWNER/MEDICAL DIRECTOR
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Name | JAY ERIAH SHANKAR
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Credential | M.D.
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Telephone | 760-241-3306
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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 | CA
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