Provider Demographics
NPI:1912042342
Name:RENAL CONSULTANTS MEDICAL GROUP
Entity Type:Organization
Organization Name:RENAL CONSULTANTS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINOD
Authorized Official - Middle Name:M
Authorized Official - Last Name:ASSOMULL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-366-4626
Mailing Address - Street 1:10605 BALBOA BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-6342
Mailing Address - Country:US
Mailing Address - Phone:818-366-4626
Mailing Address - Fax:818-366-4630
Practice Address - Street 1:23928 LYONS AVE STE 205
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2455
Practice Address - Country:US
Practice Address - Phone:661-254-0193
Practice Address - Fax:661-254-2248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW7774AMedicare PIN