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General NPI Number Information
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NPI Number | 1669798823
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Entity Type | Organization
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Legal Business Name | MOHAVE NEPHROLOGY,PC
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Dates
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Enumeration Date | 04/13/2010
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Last Update Date | 02/04/2014
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Provider Practice Location Address
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Address Line | 3535 E ANDY DEVINE AVE
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City | KINGMAN
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State | AZ
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Zip | 86401-3412
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Country | US
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Telephone | 928-757-2050
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Fax | 928-757-2020
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Provider Business Mailing Address
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Address Line | 3535 E ANDY DEVINE AVE
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City | KINGMAN
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State | AZ
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Zip | 86401-3412
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Country | US
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Telephone | 928-757-2050
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Fax | 928-757-2020
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Authorized Official
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Title or Position | PRES
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Name | DR. VIJAYAVEL PALANICHAMY
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Credential | M.D.
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Telephone | 928-757-2050
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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 | 27022
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License Number State | AZ
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