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NPI Code Detail

MEDICARE: L A COUNTY NEPHROLOGY ASSOCIATES A MEDICAL CORPORATION

MEDICARE: L A COUNTY NEPHROLOGY ASSOCIATES A MEDICAL CORPORATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1C13392OTHERCARAILROAD MEDICARE GROUP

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6ZZZ447842OTHERCABLUE SHIELD GROUP NUMBER

General Provider Information

NPI Number : 1083649651
Entity Type Code : Organization
Provider Name (Legal Business Name) : L A COUNTY NEPHROLOGY ASSOCIATES A MEDICAL CORPORATION
Provider Business Mailing Address
First Line : PO BOX 22036
Second Line :
City : BELFAST
State : ME
Zip : 04915-4117
Country : US
Telephone Number : 323-726-3868
Fax Number : 323-726-3870
Provider Business Practice Location Address
First Line : 3114 W BEVERLY BLVD
Second Line :
City : MONTEBELLO
State : CA
Zip : 90640-2217
Country : US
Telephone Number : 323-726-1317
Fax Number : 323-726-3870
Authorized Official
Title or Position : OFFICE MANAGER
Name : MS. SANDY MARINO
Credential :
Telephone Number : 323-726-3868
Provider Enumeration Date : 07/12/2006
Last Update Date : 06/26/2024

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Directions to “L A COUNTY NEPHROLOGY ASSOCIATES A MEDICAL CORPORATION ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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