Fountain Valley Regional Dialysis Center LLC
Clinic/Center, End-Stage Renal Disease (ESRD) Treatment in Fountain Valley, CA. Organization (NPI-2).
NPI number1265633747
StatusActive
Last updated in NPPESNov 27, 2012
Details
- NPI
- 1265633747
- Entity type
- Organization (NPI-2)
- Legal business name
- Fountain Valley Regional Dialysis Center LLC
- Organization subpart
- No
- Enumeration date
- May 30, 2007
- Last updated
- Nov 27, 2012
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QE0700X | Clinic/Center, End-Stage Renal Disease (ESRD) Treatment | 550001163 | CA | Yes |
Practice location
17150 Euclid AvenueSuite 111
Fountain Valley, CA 92708-4092
Phone 714-966-1595 · Fax 714-966-1555
Mailing address
3356 W Ball RdSuite 216
Anaheim, CA 92804-3702
Phone 714-226-0818 · Fax 714-226-0700
Authorized official
Gadsalli Ramaswamy Ravikumar
President/Ceo
7142260818
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