Organization
SOUTHLAND RENAL MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANDRA RODRIGUEZ (OFFICE MANAGER)
(562) 630-3111
Entity
Organization
Contact information
Practice address
2865 ATLANTIC AVE, SUITE 101, LONG BEACH, CA 90806-1740
(562) 427-0350
(560) 630-3107
Mailing address
3650 SOUTH ST, SUITE 301, LAKEWOOD, CA 90712-1502
(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
—
GR0093372
—
CA
Enumeration date
03/13/2007
Last updated
05/19/2008
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