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General NPI Number Information
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NPI Number | 1710284427
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Entity Type | Organization
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Legal Business Name | HOA VU MD INC
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Dates
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Enumeration Date | 02/15/2011
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Last Update Date | 02/15/2011
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Provider Practice Location Address
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Address Line | 330 N D ST #320
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City | SAN BERNARDINO
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State | CA
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Zip | 92401-1545
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Country | US
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Telephone | 909-381-3900
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9057
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City | REDLANDS
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State | CA
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Zip | 92375-2257
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Country | US
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Telephone | 951-738-0968
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Fax |
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Authorized Official
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Title or Position | ACCOUNT MANAGER
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Name | MS. KIMBERLY DIANE SWANSON
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Credential |
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Telephone | 951-738-0968
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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 | A62459
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License Number State | CA
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