# SOUTHLAND RENAL MEDICAL GROUP, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134252679
- **Authorized official:** CORA FISCHMAN (COO)
- **Authorized official phone:** (562) 630-3111

## Contact information

- **Practice address:** 18111 BROOKHURST ST STE 6700, FOUNTAIN VALLEY, CA 92708
- **Practice address phone:** (562) 630-3111
- **Practice address fax:** (562) 630-3107
- **Mailing address:** 3300 E SOUTH ST STE 308, LAKEWOOD, CA 90805-4598
- **Mailing address phone:** (562) 630-3111
- **Mailing address fax:** (562) 630-3107

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RN0300X | Nephrology Physician | A46344 | CA | Yes |

## Other

- **Enumeration date:** 03/13/2007
- **Last updated:** 08/15/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GR0093374 | — | CA |