Organization
KIDNEY CENTER OF THOUSAND OAKS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA VIRAL UPPONI (DIRECTOR OF ACCOUNTS RECEIVABLE)
(805) 433-7506
Entity
Organization
Contact information
Practice address
375 ROLLING OAKS DR, SUITE # 100, THOUSAND OAKS, CA 91361-1023
(805) 557-1036
(805) 557-1173
Mailing address
PO BOX 940838, SIMI VALLEY, CA 93094-0838
(805) 433-7777
(805) 433-7655
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CDC02873F
—
CA
01
—
ZZZ02842Z
BLUE SHIELD
CA
Enumeration date
06/18/2006
Last updated
01/07/2008
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