Provider Demographics
NPI:1932534021
Name:RENAL CONSULTANTS OF VENTURA COUNTY, INC
Entity type:Organization
Organization Name:RENAL CONSULTANTS OF VENTURA COUNTY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CALBERT
Authorized Official - Middle Name:ALVIS
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-383-9727
Mailing Address - Street 1:4000 CALLE TECATE STE 115
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-5285
Mailing Address - Country:US
Mailing Address - Phone:805-485-2400
Mailing Address - Fax:805-233-3025
Practice Address - Street 1:2438 N PONDEROSA DR
Practice Address - Street 2:SUITE # C-101
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2369
Practice Address - Country:US
Practice Address - Phone:805-383-9727
Practice Address - Fax:805-764-0176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-06
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB213971Medicare PIN