Organization Active NPI

Valley Nephrology Medical Group

  • Nephrology Physician
  • Fresno, CA
National Provider Identifier
1063618296
Registry record updated Jan 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
G13844 Issued in CA
Legal business name
VALLEY NEPHROLOGY MEDICAL GROUP
Practice address
1313 E Herndon Ave
Suite 105
Fresno, CA 93720-3306
Phone
(559) 448-8481
Fax
(559) 448-0996
NPI assigned
Jun 25, 2007
Last updated
Jan 16, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Leonor Q Garbutt
Title
Office Administrator
Phone
(559) 448-8481

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X G13844 CA Primary

Addresses

Primary practice location

1313 E Herndon Ave
Suite 105
Fresno, CA 93720-3306

Mailing address

1313 E Herndon Ave
Suite 105
Fresno, CA 93720-3306
Phone (559) 448-8481

Other identifiers 3

IdentifierTypeStateIssuer
00G138440MedicaidCA
G13844OtherCASTATE LICENSE
GR0023120MedicaidCA

National Provider Directory

National Provider Directory

Locations

3845 N Clark St
Ste 103
Fresno, CA 93726
Phone (559) 227-8481

1313 E Herndon Ave
Ste 105
Fresno, CA 93720
Phone (559) 448-8481

1191 E Herndon Ave
Fresno, CA 93720

1115 W 4TH St Ste a
Madera, CA 93637

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1232064000000",
    "number": "1063618296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1313 E HERNDON AVE",
            "address_2": "SUITE 105",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937203306",
            "telephone_number": "559-448-8481",
            "fax_number": "559-448-0996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1313 E HERNDON AVE",
            "address_2": "SUITE 105",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937203306",
            "telephone_number": "559-448-8481",
            "fax_number": "559-448-0996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLEY NEPHROLOGY MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-25",
        "last_updated": "2009-01-16",
        "status": "A",
        "authorized_official_last_name": "GARBUTT",
        "authorized_official_first_name": "LEONOR",
        "authorized_official_middle_name": "Q",
        "authorized_official_title_or_position": "OFFICE ADMINISTRATOR",
        "authorized_official_telephone_number": "559-448-8481",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "G13844",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G138440",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "G13844",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0023120",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.