1881234128 NPI number — MODERN NEPHROLOGY A PROFESSIONAL MEDICAL CORPORATION

Table of content: (NPI 1881234128)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881234128 NPI number — MODERN NEPHROLOGY A PROFESSIONAL MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MODERN NEPHROLOGY A PROFESSIONAL MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
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Provider Other Last Name:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1881234128
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16834 ARMSTEAD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRANADA HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91344-2703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18040 SHERMAN WAY STE 210
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RESEDA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91335-4631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-371-0338
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/15/2020

Additional Information

Authorized Official

Authorized Official Last Name:
PAPAZIAN
Authorized Official First Name:
VARTAN
Authorized Official Middle Name:
DANIEL
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
818-371-0338

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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