Provider Demographics
NPI:1235150400
Name:CAPITOL NEPHROLOGY MEDICAL GROUP
Entity Type:Organization
Organization Name:CAPITOL NEPHROLOGY MEDICAL GROUP
Other - Org Name:CAPITAL NEPHROLOGY MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:TANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-426-1949
Mailing Address - Street 1:1111 EXPOSITION BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4324
Mailing Address - Country:US
Mailing Address - Phone:916-929-8564
Mailing Address - Fax:916-929-4529
Practice Address - Street 1:333 UNIVERSITY AVE STE 120
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6532
Practice Address - Country:US
Practice Address - Phone:916-929-8564
Practice Address - Fax:916-929-4529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0015060Medicaid
CAGR0015060Medicaid