Provider Demographics
NPI:1083649651
Name:L.A. COUNTY NEPHROLOGY ASSOCIATES A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:L.A. COUNTY NEPHROLOGY ASSOCIATES A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-726-3868
Mailing Address - Street 1:PO BOX 22036
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4117
Mailing Address - Country:US
Mailing Address - Phone:323-726-3868
Mailing Address - Fax:323-726-3870
Practice Address - Street 1:3114 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-2217
Practice Address - Country:US
Practice Address - Phone:323-726-1317
Practice Address - Fax:323-726-3870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0052992Medicaid
CA00A792790Medicaid
CAZZZ447842OtherBLUE SHIELD GROUP NUMBER
CAC13392OtherRAILROAD MEDICARE GROUP
CAGR0052991Medicaid
CAGR0052990Medicaid
CAGR0052991Medicaid
CAF01869Medicare UPIN
CAP90360Medicare UPIN
CAH18737Medicare UPIN
CAQ56774Medicare UPIN
CAI57363Medicare UPIN
CA00A792790Medicaid
CAGR0052990Medicaid
CAP50772Medicare UPIN
CAC13392OtherRAILROAD MEDICARE GROUP
CAP50772Medicare UPIN