Organization
ST MICHAEL NEPHROLOGY, PLLC
Active
Other names
St Mikes Neph
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERNEST DANIEL MORENO DYTIAPCO MD (NEPHROLOGIST)
(986) 200-8202
Entity
Organization
Contact information
Practice address
1674 S LOGGERS POND PL APT 14, BOISE, ID 83706-7517
(986) 200-8202
(626) 593-4751
Mailing address
999 W MAIN ST STE 100, BOISE, ID 83702-9001
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Enumeration date
05/26/2019
Last updated
07/14/2019
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