| Organization Name: | LA PALMA DIALYSIS CENTER LLC |
| NPI Number: | 1235157116 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GADSALLI RAMASWAMY RAVIKUMAR (PRESIDENT/CEO) |
| Mailing Address: | 5451 La Palma Ave Suite 35 La Palma |
| State: | CA US |
| Postal Code: | 906231728 |
| Phone Number: | 7145235970 |
| Fax Number: | 7145234404 |
| NPI Enumeration Date: | 07/18/2006 |
| NPI Last Update Date: | 11/27/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QE0700X |
| License Number: | 080000679 |
| 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: | |