Organization
KIDNEY CENTER OF SANTA PAULA
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
253 MARCH ST, SANTA PAULA, CA 93060-2511
(805) 525-3977
(805) 525-4746
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
—
CDC02800F
—
CA
01
—
ZZZ58738Z
BLUE SHIELD
CA
Enumeration date
06/18/2006
Last updated
01/07/2008
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