MEDICARE: COASTAL 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

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	:	1588920870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL DIALYSIS CENTER, LLC

Provider Business Mailing Address
First Line	:	641 UNIVERSITY BLVD STE 209
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-2794
Country	:	US
Telephone Number	:	561-557-1704
Fax Number	:

Provider Business Practice Location Address
First Line	:	641 UNIVERSITY BLVD STE 209
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-2794
Country	:	US
Telephone Number	:	561-253-8121
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ABBAS RABIEI
Credential	:	MD
Telephone Number	:	561-557-1704

Provider Enumeration Date	:	04/11/2012
Last Update Date	:	09/03/2025

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