MEDICARE: CAPITAL DIALYSIS PARTNERSHIP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	110000472	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215990684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPITAL DIALYSIS PARTNERSHIP

Provider Business Mailing Address
First Line	:	5200 VIRGINIA WAY
Second Line	:	L&C DEPT
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7569
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4612 ROSEVILLE RD STE 100
Second Line	:
City	:	NORTH HIGHLANDS
State	:	CA
Zip	:	95660-5175
Country	:	US
Telephone Number	:	916-334-1368
Fax Number	:	916-334-1543

Authorized Official
Title or Position	:	VP LICENSURE & CERTIFICATION
Name	:	SAMUEL T WEY
Credential	:
Telephone Number	:	615-341-6641

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	05/06/2025

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1326152497 — TARA L. NOWLING
Practice Location Address:

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1174632228 — MRS. YVETTE ELIZABETH DIXON MFT/IMF
Practice Location Address:

4612 ROSEVILLE RD
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95660-5175

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1013052232 — KATHLEEN MARY GARCIA
Practice Location Address:

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1093840357 — MS. JORDANA INGE DIEHL
Practice Location Address:

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1609902998 — CHAKIA DAVIES
Practice Location Address:

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Practice Fax:

Directions to “CAPITAL DIALYSIS PARTNERSHIP ” Practice Location

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