Organization Name: | GREATER LOS ANGELES DIALYSIS INC |
NPI Number: | 1922181056 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARINO B DE PERALTA (VICE PRESIDENT/CFO) |
Mailing Address: | 11204 Rush St South El Monte |
State: | CA US |
Postal Code: | 917333551 |
Phone Number: | 6265714596 |
Fax Number: | 6265711706 |
NPI Enumeration Date: | 10/23/2006 |
NPI Last Update Date: | 06/30/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QE0700X |
License Number: | 930000865 |
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: |