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General NPI Number Information
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NPI Number | 1801985874
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Entity Type | Organization
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Legal Business Name | SANTA CRUZ NEPHROLOGY MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 12/07/2012
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Provider Practice Location Address
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Address Line | 1595 SOQUEL DR. STE. 210
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City | SANTA CRUZ
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State | CA
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Zip | 95065-1721
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Country | US
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Telephone | 831-476-1551
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Fax | 831-476-3241
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Provider Business Mailing Address
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Address Line | 1595 SOQUEL DR STE 210
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City | SANTA CRUZ
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State | CA
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Zip | 95065-1721
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Country | US
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Telephone | 831-476-1551
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Fax | 831-476-3241
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Authorized Official
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Title or Position | ACCOUNT MANAGER
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Name | MRS. MARILU NAKATANI
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Credential |
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Telephone | 831-476-1551
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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 | A72787
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | A76684
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | A32324
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License Number State | CA
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