Provider Demographics
NPI:1568424679
Name:NEPHROLOGY SPECIALISTS MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:NEPHROLOGY SPECIALISTS MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMER
Authorized Official - Middle Name:
Authorized Official - Last Name:JABARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-639-4901
Mailing Address - Street 1:705 W LA VETA AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4447
Mailing Address - Country:US
Mailing Address - Phone:714-693-7901
Mailing Address - Fax:714-771-5389
Practice Address - Street 1:705 W LA VETA AVE STE 107
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-639-4901
Practice Address - Fax:714-771-5389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ81344ZMedicaid
CAZZZ73100ZMedicaid
CAW1089BMedicare PIN
CAZZZ81344ZMedicaid