Provider Demographics
NPI:1093776304
Name:NEPHROLOGY MEDICAL GROUP INC OF ORANGE COUNTY
Entity Type:Organization
Organization Name:NEPHROLOGY MEDICAL GROUP INC OF ORANGE COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-956-5200
Mailing Address - Street 1:1019 W LA PALMA AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-3664
Mailing Address - Country:US
Mailing Address - Phone:714-956-5200
Mailing Address - Fax:714-956-4614
Practice Address - Street 1:1019 W LA PALMA AVE UNIT A
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-3664
Practice Address - Country:US
Practice Address - Phone:714-956-5200
Practice Address - Fax:714-956-4614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW1088Medicare ID - Type Unspecified