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General NPI Number Information
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NPI Number | 1790342897
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Entity Type | Organization
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Legal Business Name | NORTHRIDGE KIDNEY CENTER, LLC
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Dates
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Enumeration Date | 05/23/2019
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Last Update Date | 06/07/2022
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Provider Practice Location Address
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Address Line | 17710 ROSCOE BLVD
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City | NORTHRIDGE
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State | CA
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Zip | 91325-3910
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Country | US
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Telephone | 818-739-4888
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Fax | 747-265-6106
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Provider Business Mailing Address
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Address Line | 23421 LYONS AVE
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City | SANTA CLARITA
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State | CA
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Zip | 91355-3028
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Country | US
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Telephone | 818-903-3186
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | PARAG SHAH
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Credential | MD
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Telephone | 818-365-1194
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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