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General NPI Number Information
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NPI Number | 1972741130
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Entity Type | Organization
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Legal Business Name | VALLEY KIDNEY INSTITUTE
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Dates
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Enumeration Date | 01/27/2009
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Last Update Date | 01/27/2009
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Provider Practice Location Address
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Address Line | 900 PLAZA DRIVE STE #5
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City | MISSION
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State | TX
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Zip | 78572-6049
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Country | US
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Telephone | 956-583-0095
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Fax | 956-583-2118
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Provider Business Mailing Address
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Address Line | 900 PLAZA DRIVE STE #5
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City | MISSION
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State | TX
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Zip | 78572-6049
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Country | US
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Telephone | 956-583-0095
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Fax | 956-583-2118
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Authorized Official
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Title or Position | PRESIDENT
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Name | MOHAMMAD HOSEIN KOTAKI
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Credential | MD
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Telephone | 956-583-0095
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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 | K0877
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License Number State | TX
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