Basic Information
| Provider Information | |||||||||
| NPI: | 1932534021 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RENAL CONSULTANTS OF VENTURA COUNTY, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4000 CALLE TECATE STE 115 | ||||||||
| Address2: | |||||||||
| City: | CAMARILLO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930125285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054852400 | ||||||||
| FaxNumber: | 8052333025 | ||||||||
| Practice Location | |||||||||
| Address1: | 2438 N PONDEROSA DR | ||||||||
| Address2: | SUITE # C-101 | ||||||||
| City: | CAMARILLO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930102369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8053839727 | ||||||||
| FaxNumber: | 8057640176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2013 | ||||||||
| LastUpdateDate: | 04/26/2022 | ||||||||
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| AuthorizedOfficialLastName: | WONG | ||||||||
| AuthorizedOfficialFirstName: | CALBERT | ||||||||
| AuthorizedOfficialMiddleName: | ALVIS | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8053839727 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 04/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.