Organization
SANTA CRUZ NEPHROLOGY MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARILU NAKATANI (ACCOUNT MANAGER)
(831) 476-1551
Entity
Organization
Contact information
Practice address
1595 SOQUEL DR., STE. 210, SANTA CRUZ, CA 95065-1721
(831) 476-1551
(831) 476-3241
Mailing address
1595 SOQUEL DR STE 210, SANTA CRUZ, CA 95065-1721
(831) 476-1551
(831) 476-3241
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
A32324
CA
207RN0300X
Nephrology Physician
A72787
CA
207RN0300X
Nephrology Physician
A76684
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A320240
—
CA
01
—
DD5840
MEDICARE RR GROUP#
CA
01
—
ZZZ66323Z
BLUE SHIELD PROVIDER ID
CA
Enumeration date
10/11/2006
Last updated
12/07/2012
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