Provider Demographics
NPI:1083705941
Name:NEPHROLOGY ASSOCIATES MEDICAL GROUP
Entity Type:Organization
Organization Name:NEPHROLOGY ASSOCIATES MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:FENECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-680-9717
Mailing Address - Street 1:4361 LATHAM ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-1730
Mailing Address - Country:US
Mailing Address - Phone:951-680-9717
Mailing Address - Fax:951-680-9327
Practice Address - Street 1:264 N HIGHLAND SPRINGS AVE
Practice Address - Street 2:SUITE 2D
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-3082
Practice Address - Country:US
Practice Address - Phone:951-769-9776
Practice Address - Fax:951-769-9026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty