Organization
VALLEY INTERNAL MEDICINE & NEPHROLOGY MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAULA MARTINEZ (CREDENTIALING)
(818) 908-8048
Entity
Organization
Contact information
Practice address
15211 VANOWEN ST, SUITE 315, VAN NUYS, CA 91405-3606
(818) 787-2410
(818) 756-0723
Mailing address
5805 SEPULVEDA BLVD, SUITE 610, VAN NUYS, CA 91411-2546
(818) 908-8048
(818) 908-8072
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0063960
—
CA
Enumeration date
07/10/2006
Last updated
05/25/2010
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