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General NPI Number Information
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NPI Number | 1760586705
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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 | 09/11/2006
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Last Update Date | 11/30/2016
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Provider Practice Location Address
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Address Line | 13990 BEAR FENCE CT
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City | MOORPARK
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State | CA
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Zip | 93021-5022
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Country | US
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Telephone | 818-718-2301
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Fax | 818-718-2311
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Provider Business Mailing Address
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Address Line | PO BOX 2160
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City | MOORPARK
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State | CA
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Zip | 93020-2160
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Country | US
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Telephone | 818-718-2301
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Fax | 818-718-2311
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOYCE VAN BRUCK
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Credential |
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Telephone | 818-400-6396
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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 |
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