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Organization
SOUTHLAND RENAL MEDICAL GROUP, INC
Active
Organization
SOUTHLAND RENAL MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CORA FISCHMAN (COO)
(562) 630-3111
Entity
Organization
Contact information
Practice address
18111 BROOKHURST ST STE 6700, FOUNTAIN VALLEY, CA 92708
(562) 630-3111
(562) 630-3107
Mailing address
3300 E SOUTH ST STE 308, LAKEWOOD, CA 90805-4598
(562) 630-3111
(562) 630-3107
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
A46344
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0093374
—
CA
Enumeration date
03/13/2007
Last updated
08/15/2018
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