Provider Demographics
NPI:1982631222
Name:NEPHROLOGY ASSOCIATES OF UPLAND AND POMONA
Entity Type:Organization
Organization Name:NEPHROLOGY ASSOCIATES OF UPLAND AND POMONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:HENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-981-5882
Mailing Address - Street 1:PO BOX 1869
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91785-1869
Mailing Address - Country:US
Mailing Address - Phone:909-981-5882
Mailing Address - Fax:909-385-0379
Practice Address - Street 1:1317 W FOOTHILL BLVD STE 148
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3675
Practice Address - Country:US
Practice Address - Phone:909-981-5882
Practice Address - Fax:909-373-2828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0025730Medicaid
CAGR0025733Medicaid
CAGR0025734Medicaid
CAGR0025731Medicaid
CAGR0025732Medicaid
CAGR0025734Medicaid
CAZZZ18210ZMedicare PIN
CAGR0025730Medicaid
CAGR0025733Medicaid
CAZZZ39982ZMedicare PIN