| Organization Name: | KIDNEY DIALYSIS CENTER OF SAN LUIS OBISPO,LLC |
| NPI Number: | 1033151816 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LISA VIRAL UPPONI (DIRECTOR OF ACCOUNTS RECEIVABLE) |
| Mailing Address: | 1043 Marsh St San Luis Obispo |
| State: | CA US |
| Postal Code: | 934013629 |
| Phone Number: | 8055431013 |
| Fax Number: | 8055435654 |
| NPI Enumeration Date: | 06/13/2006 |
| NPI Last Update Date: | 01/07/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QE0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
| Taxonomy Definition: | |