Peninsula Nephrology, Inc.

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

PENINSULA NEPHROLOGY, INC.

Practice address

2000 S El Camino Real
San Mateo, CA 94403-1805

Phone

(650) 377-0200

Fax

(650) 358-3906

NPI assigned

Aug 10, 2005

Organization subpart

No

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

Authorized official

Name

Ms. Cynthia Jansen, RN, BS, MBA

Title

Ceo

Phone

(650) 377-0200

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• San Mateo Dialysis Center Doing business as

Tax ID family

Peninsula Nephrology Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Peninsula Nephrology, Inc.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • San Mateo, CA
  • NPI 1518969039
  NPD tax ID

Locations

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

{
    "created_epoch": "1123632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1235130352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 S EL CAMINO REAL",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944031805",
            "telephone_number": "650-377-0200",
            "fax_number": "650-358-3906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 S EL CAMINO REAL",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944031805",
            "telephone_number": "650-377-0200",
            "fax_number": "650-358-3906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA NEPHROLOGY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JANSEN",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "650-377-0200",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN, BS, MBA"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CDC02819F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Mateo Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Peninsula Family YMCA
• Peninsula Foot & Ankle Center Corp
• Peninsula Gastrointestinal
• Peninsula Health Care District
• Peninsula Medical Associates
• Peninsula Nephrology, Inc.
• Peninsula OBGYN Integrative
• Peninsula Pediatric Dental Practice
• Peninsula Pediatric Med GRP Inc
• Peninsula Spine & Sports Rehab, a Rommel Hindocha Chiropractic Corp.

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in San Mateo, CA
• Providers in San Mateo, CA by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.