Provider Demographics
NPI:1730646266
Name:HIGH DESERT NEPHROLOGY MEDICAL ASSOCIATES INC.
Entity Type:Organization
Organization Name:HIGH DESERT NEPHROLOGY MEDICAL ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHANKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-241-3306
Mailing Address - Street 1:12675 HESPERIA ROAD
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-9224
Mailing Address - Country:US
Mailing Address - Phone:960-241-3306
Mailing Address - Fax:760-241-6243
Practice Address - Street 1:11883 AMETHYST ROAD STE # 100
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-9224
Practice Address - Country:US
Practice Address - Phone:760-998-2060
Practice Address - Fax:960-998-2068
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HIGH DESERT NEPHROLOGY MEDICAL ASSOCIATES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty