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General NPI Number Information
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NPI Number | 1649291774
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Entity Type | Organization
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Legal Business Name | CALIFORNIA KIDNEY MEDICAL GROUP INC
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 02/26/2009
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Provider Practice Location Address
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Address Line | 50 MORELAND RD
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City | SIMI VALLEY
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State | CA
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Zip | 93065-1659
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Country | US
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Telephone | 805-433-7360
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Fax | 805-306-0620
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Provider Business Mailing Address
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Address Line | PO BOX 940838
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City | SIMI VALLEY
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State | CA
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Zip | 93094-0838
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Country | US
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Telephone | 805-433-7777
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Fax | 805-433-7607
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | LILY KRASTEIN
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Credential |
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Telephone | 805-433-7507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | CLF 320950
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License Number State | CA
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