Provider Demographics
NPI:1285667659
Name:PEDIATRIC RENAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PEDIATRIC RENAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DEEPAK
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:RAJPOOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-669-3173
Mailing Address - Street 1:9 CANDELA
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-1823
Mailing Address - Country:US
Mailing Address - Phone:714-669-3173
Mailing Address - Fax:
Practice Address - Street 1:9 CANDELA
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-1823
Practice Address - Country:US
Practice Address - Phone:714-669-3173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA483162080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric NephrologyGroup - Single Specialty