Santa Cruz Nephrology Medical Group, Inc.

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

A32324 Issued in CA

Legal business name

SANTA CRUZ NEPHROLOGY MEDICAL GROUP, INC.

Practice address

1595 Soquel Dr.
Ste. 210
Santa Cruz, CA 95065-1721

Phone

(831) 476-1551

Fax

(831) 476-3241

NPI assigned

Oct 11, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Marilu Nakatani

Title

Account Manager

Phone

(831) 476-1551

Specialties & licenses 3

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354838400000",
    "number": "1801985874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1595 SOQUEL DR STE 210",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950651721",
            "telephone_number": "831-476-1551",
            "fax_number": "831-476-3241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1595 SOQUEL DR.",
            "address_2": "STE. 210",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950651721",
            "telephone_number": "831-476-1551",
            "fax_number": "831-476-3241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTA CRUZ NEPHROLOGY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2012-12-07",
        "status": "A",
        "authorized_official_last_name": "NAKATANI",
        "authorized_official_first_name": "MARILU",
        "authorized_official_title_or_position": "ACCOUNT MANAGER",
        "authorized_official_telephone_number": "831-476-1551",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A32324",
            "primary": true
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A72787",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A76684",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROVIDER ID",
            "identifier": "ZZZ66323Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR GROUP#",
            "identifier": "DD5840",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A320240",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Nephrology Physician in Santa Cruz, CA
• Providers in Santa Cruz, CA by specialty
• Nephrology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2012; 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.