Basic Information
| Provider Information | |||||||||
| NPI: | 1295229672 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | YUMA KIDNEY & DIALYSIS SPECIALISTS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 669 | ||||||||
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| City: | YUMA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853662329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9282476516 | ||||||||
| FaxNumber: | 9283661075 | ||||||||
| Practice Location | |||||||||
| Address1: | 11468 N FRONTAGE RD | ||||||||
| Address2: | |||||||||
| City: | YUMA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9282476516 | ||||||||
| FaxNumber: | 9283661075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2018 | ||||||||
| LastUpdateDate: | 03/15/2022 | ||||||||
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| AuthorizedOfficialLastName: | FAZIL | ||||||||
| AuthorizedOfficialFirstName: | IRFAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9283667364 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 03/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207RN0300X | AZ | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.