MEDICARE: MONTEBELLO DIALYSIS CENTER, LLC

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	930000926	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	:	1548231251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTEBELLO DIALYSIS CENTER, LLC

Provider Business Mailing Address
First Line	:	PO BOX 251549
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75025-1500
Country	:	US
Telephone Number	:	214-736-2700
Fax Number	:	214-736-2855

Provider Business Practice Location Address
First Line	:	433 N 4TH ST STE 102
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-4313
Country	:	US
Telephone Number	:	323-278-5555
Fax Number	:	323-278-5554

Authorized Official
Title or Position	:	CHAIRMAN & PRESIDENT
Name	:	THOMAS L. WEINBERG
Credential	:
Telephone Number	:	214-736-2730

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	05/12/2026

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