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General NPI Number Information
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NPI Number | 1770560914
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Entity Type | Organization
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Legal Business Name | EL CAMINO RENAL MEDICAL GROUP, INC
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Dates
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Enumeration Date | 12/29/2005
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Last Update Date | 10/31/2017
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Provider Practice Location Address
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Address Line | 515 SOUTH DR SUITE 12
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94040-4204
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Country | US
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Telephone | 650-988-7944
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Fax | 650-964-3608
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Provider Business Mailing Address
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Address Line | 515 SOUTH DR SUITE 12
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94040-4204
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Country | US
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Telephone | 650-988-7944
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Fax | 650-964-3608
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Authorized Official
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Title or Position | DIRECTOR
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Name | BRIAN JAMES CARRIE
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Credential | MD
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Telephone | 650-988-7944
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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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