Provider Demographics
NPI:1265831770
Name:R & L NEPHROLOGY LLC
Entity Type:Organization
Organization Name:R & L NEPHROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:RIKKIO
Authorized Official - Last Name:DEMELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-292-4284
Mailing Address - Street 1:105 MAUI LANI PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2443
Mailing Address - Country:US
Mailing Address - Phone:808-244-9555
Mailing Address - Fax:808-244-9577
Practice Address - Street 1:105 MAUI LANI PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2443
Practice Address - Country:US
Practice Address - Phone:808-244-9555
Practice Address - Fax:808-244-9577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty