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Organization
VALLEY KIDNEY CLINIC INC
Active
Organization
VALLEY KIDNEY CLINIC INC
Active
Other names
Valley Kidney Clinic Inc
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MALLAREDDY MADDULA MD (MD)
(209) 546-1868
Entity
Organization
Contact information
Practice address
1801 E MARCH LN, SUITE B265, STOCKTON, CA 95210-6629
(209) 546-1868
(209) 461-6505
Mailing address
1801 E MARCH LN, SUITE B265, STOCKTON, CA 95210-6629
(209) 546-1868
(209) 461-6505
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A108120
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A108120
STATE LICENSE
CA
01
—
CB972A
MEDICARE
CA
Enumeration date
07/13/2009
Last updated
06/19/2015
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