Provider Demographics
NPI:1275954711
Name:SAN FERNANDO WEST KIDNEY CENTER L.P
Entity Type:Organization
Organization Name:SAN FERNANDO WEST KIDNEY CENTER L.P
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:P
Authorized Official - Last Name:GUZIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-345-0664
Mailing Address - Street 1:7230 MEDICAL CENTER DR STE 205
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-4007
Mailing Address - Country:US
Mailing Address - Phone:818-345-0664
Mailing Address - Fax:818-657-0131
Practice Address - Street 1:7230 MEDICAL CENTER DR STE 101
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-4001
Practice Address - Country:US
Practice Address - Phone:818-888-4730
Practice Address - Fax:818-888-3460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-31
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QE0700X261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA052588Medicare PIN