Organization
CALIFORNIA KIDNEY MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOYCE VAN BRUCK (ADMINISTRATOR)
(818) 400-6396
Entity
Organization
Contact information
Practice address
13990 BEAR FENCE CT, MOORPARK, CA 93021-5022
(818) 718-2301
(818) 718-2311
Mailing address
PO BOX 2160, MOORPARK, CA 93020-2160
(818) 718-2301
(818) 718-2311
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0087560
—
CA
Enumeration date
09/11/2006
Last updated
11/30/2016
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