Organization
SOUTHLAND RENAL MEDICAL GROUP, INC.
Active
Parent organization
SOUTHLAND RENAL MEDICAL GROUP, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHLAND RENAL MEDICAL GROUP, INC.
Authorized official
AVEDIK SEMERJIAN MD (SECRETARY)
(562) 630-3111
Entity
Organization
Contact information
Practice address
4152 KATELLA AVE STE 201, LOS ALAMITOS, CA 90720-6608
(562) 630-3111
(562) 630-3107
Mailing address
3300 E. SOUTH STREET, SUITE 308, LONG BEACH, 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
—
GR0093371
—
CA
Enumeration date
03/13/2007
Last updated
07/08/2024
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