CENTRAL COAST NEPHROLOGY MEDICAL CORPORATION (NPI# 1366550675) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366550675 |
| Entity Type | Organization |
| Organization Name | CENTRAL COAST NEPHROLOGY MEDICAL CORPORATION |
| Practice Address |
917 Blanco Circle Salinas CA 93901-4446 |
| Practice Telephone | 8317557999 |
| Practice Fax Number | 8317557975 |
| Mailing Telephone | 8317557999 |
| Mailing Fax Number | 8317557975 |
| Enumeration Date | 2006-08-27 |
| Last Update Date | 2016-10-05 |
| Authorized Official Name | MRS. BARBARA LOIS REVER (PRESIDENT) |
| Authorized Official Telephone | 8317557999 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RN0300X |
Internal Medicine Specialization: Nephrology |
G308710 | CA | Allopathic & Osteopathic Physicians |
| N | 207RN0300X |
Internal Medicine Specialization: Nephrology |
G507670 | CA | Allopathic & Osteopathic Physicians |
| N | 207RN0300X |
Internal Medicine Specialization: Nephrology |
A66902 | CA | Allopathic & Osteopathic Physicians |
| N | 207RN0300X |
Internal Medicine Specialization: Nephrology |
A767040 | CA | Allopathic & Osteopathic Physicians |
| N | 207RN0300X |
Internal Medicine Specialization: Nephrology |
A116032 | CA | Allopathic & Osteopathic Physicians |
| Y | 207RN0300X |
Internal Medicine Specialization: Nephrology |
A36123 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | MICHAEL E DICUS MD DEA | BP6188824 | 01 |
| CA | 00G507670 | 05 | |
| CA | MEDICARE PTAN ANNA MALKINA, MD | ZZZ24103Z | 01 |
| CA | 00A669020 | 05 | |
| CA | 00A767040 | 05 | |
| CA | 00G308710 | 05 | |
| CA | BARBARA L REVER MD DEA | AR9620368 | 01 |
| CA | 00A361230 | 05 | |
| CA | GOPAL G KRISHNA MD DEA | AK9664207 | 01 |
| CA | DENNIS PHAN MD DEA | BP7526001 | 01 |
| CA | RAYMOND R CARRILLO MD DEA | AC2224208 | 01 |
| Street Address |
917 BLANCO CIRCLE |
| City | SALINAS |
| State | CA |
| Zip Code | 93901-4446 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255410262 | Barbara Lois Rever | Internal Medicine | 917 Blanco Circle, Salinas, CA 93901-4446 | 2006-11-02 |
| 1073692083 | Gopal Gollapupi Krishna | Internal Medicine | 917 Blanco Circle, Salinas, CA 93901-4446 | 2006-11-02 |
| 1437238342 | Dennis Namphong Phan | Internal Medicine | 917 Blanco Circle, Salinas, CA 93901-4446 | 2006-11-02 |
| 1447339452 | Michael Eugene Dicus | Internal Medicine | 917 Blanco Circle, Salinas, CA 93901-4446 | 2006-11-02 |
| 1265511273 | Raymond Richard Carrillo Jr. | Internal Medicine | 917 Blanco Circle, Salinas, CA 93901-4446 | 2006-11-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043811482 | Ofelia Stephanie Gonzalez | Social Worker | 252 San Jose St. Upstairs Suite, Salinas, CA 93901 | 2020-11-03 |
| 1881222198 | Megan Emery | Occupational Therapist | Monterey County Office of Education, 901 Blanco Circle, Salinas, CA 93901 | 2020-03-31 |
| 1083171433 | Leeann Rose Gutierrez | Behavior Technician | 505 E Romie Lane, Suite E, Salinas, CA 93901 | 2019-02-21 |
| 1043784853 | Jeanne Miranda Gapac Brady | Pharmacy | 420 East Romie Lane, Salinas, CA 93901 | 2019-01-15 |
| 1164994422 | Epigmenio Vazquez | Behavior Technician | 505 E Romie Lane, Salinas, CA 93901 | 2018-12-27 |
| 1043709751 | Stephanie Gailo | Registered Nurse | Dept of Social Services, Family & Children's Services., 1000 S. Main St. Ste 205, Salinas, CA 93901 | 2018-05-08 |
| 1912405846 | Elizabeth Zaragoza | Counselor | 130 W. Gabilan Street, Salinas, CA 93901 | 2018-01-25 |
| 1144749540 | Shelby Lynn Hyosaka | Registered Nurse | 333 Abbott St. - United Ag Health and Wellness Center, Ste. A, Salinas, CA 93901 | 2017-09-17 |
| 1275058075 | Marisol Jacobo | Social Worker | 41 E San Luis St., Salinas, CA 93901 | 2017-08-14 |
| 1225484959 | Kristen Ryan Russell | Occupational Therapist | Windsor Gardens Center of Rehabilitation, 637 E Romie Ln, Salinas, CA 93901 | 2016-05-12 |
| Find all providers in zip 93901 | ||||
| Taxonomy Code | 207RN0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Nephrology |
| An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255410262 | Barbara Lois Rever | Internal Medicine | 917 Blanco Circle, Salinas, CA 93901-4446 | 2006-11-02 |
| 1073692083 | Gopal Gollapupi Krishna | Internal Medicine | 917 Blanco Circle, Salinas, CA 93901-4446 | 2006-11-02 |
| 1437238342 | Dennis Namphong Phan | Internal Medicine | 917 Blanco Circle, Salinas, CA 93901-4446 | 2006-11-02 |
| 1447339452 | Michael Eugene Dicus | Internal Medicine | 917 Blanco Circle, Salinas, CA 93901-4446 | 2006-11-02 |
| 1265511273 | Raymond Richard Carrillo Jr. | Internal Medicine | 917 Blanco Circle, Salinas, CA 93901-4446 | 2006-11-02 |
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|---|---|---|---|---|
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| 1538774989 | Modern Telehealth | Internal Medicine | 1509 Espinosa Cir, Palos Verdes Estates, CA 90274-1917 | 2020-09-12 |
| 1073137733 | Jafar Alsaid | Internal Medicine | 2009 Baywood Ln, Davis, CA 95618-0500 | 2020-05-29 |
| 1164041422 | Advanced Care Multispecialty Medical Group Apc | Internal Medicine | 13990 Bear Fence Court, Moorpark, CA 93021-5022 | 2020-04-15 |
| 1629600416 | Valley Kidney Medical Group Inc | Internal Medicine | 1646 E Herndon Ave Ste 106, Fresno, CA 93720-3380 | 2020-02-10 |
| 1437789278 | Spectrum Dialysis | Internal Medicine | 18040 Sherman Way Ste 220, Reseda, CA 91335-4631 | 2020-01-21 |
| 1932745007 | K Care Ipa | Internal Medicine | 18000 Studebaker Rd Ste 100, Cerritos, CA 90703-7929 | 2019-11-22 |
| 1326609496 | Alliance Hospitalist Medical Corporation | Internal Medicine | 3300 E South St Ste 307, Lakewood, CA 90805 | 2019-06-27 |
| 1669930723 | Adventist Health Physicians Network | Internal Medicine | 111 Raley Blvd Ste 160, Chico, CA 95928-8351 | 2019-03-07 |
| 1295293363 | Adventist Health Physicians Network | Internal Medicine | 111 Raley Blvd Ste 220, Chico, CA 95928-8351 | 2019-03-07 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.