Provider Demographics
NPI:1194757252
Name:HYPERTENSION NEPHROLOGY & INTERNAL MEDICINE GROUP INC
Entity type:Organization
Organization Name:HYPERTENSION NEPHROLOGY & INTERNAL MEDICINE GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MUTHIYALIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BABU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-349-0198
Mailing Address - Street 1:1401 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4801
Mailing Address - Country:US
Mailing Address - Phone:805-349-0198
Mailing Address - Fax:805-349-9004
Practice Address - Street 1:1401 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4801
Practice Address - Country:US
Practice Address - Phone:805-349-0198
Practice Address - Fax:805-349-9004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A415330Medicaid
CAA29400Medicare UPIN
CAW14881Medicare ID - Type Unspecified