Provider Demographics
NPI:1386965267
Name:RENAL CONSULTANTS MEDICAL GROUP
Entity type:Organization
Organization Name:RENAL CONSULTANTS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:TRESLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-366-4626
Mailing Address - Street 1:16907 DEVONSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-7407
Mailing Address - Country:US
Mailing Address - Phone:818-366-4626
Mailing Address - Fax:818-366-4644
Practice Address - Street 1:16907 DEVONSHIRE ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-7407
Practice Address - Country:US
Practice Address - Phone:818-366-4626
Practice Address - Fax:818-366-4644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW7774Medicare PIN