| Organization Name: | PERITONEAL DIALYSIS CENTER OF AMERICA - SAN GABRIEL, PC |
| NPI Number: | 1093062796 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | EVELYN DAVIS (SECRETARY) |
| Mailing Address: | 809 S Atlantic Blvd Suite 103 Monterey Park |
| State: | CA US |
| Postal Code: | 917544756 |
| Phone Number: | 6265768556 |
| Fax Number: | 6265768557 |
| NPI Enumeration Date: | 08/13/2012 |
| NPI Last Update Date: | 08/13/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QE0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
| Taxonomy Definition: | |