MEDICARE: PALO DIALYSIS 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

General Provider Information

NPI Number	:	1790308179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALO DIALYSIS LLC

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

Provider Business Practice Location Address
First Line	:	10211 LONG BEACH BLVD
Second Line	:
City	:	LYNWOOD
State	:	CA
Zip	:	90262-1508
Country	:	US
Telephone Number	:	213-460-0938
Fax Number	:	213-460-0963

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

Provider Enumeration Date	:	05/20/2020
Last Update Date	:	11/21/2025

Similar Medicare Providers

1831032184 — DR. PETER BERNARD SARCAUGA DO
Practice Location Address:

3630 E IMPERIAL HWY
LYNWOOD, CA
90262-2609

Practice Phone: 310-900-8900
Practice Fax:

1053894758 — MS. DORA DANIELS LMFT
Practice Location Address:

3559 FERNWOOD AVE
LYNWOOD, CA
90262-3485

Practice Phone: 415-569-0834
Practice Fax:

1962345025 — AMAL BUHARI
Practice Location Address:

3630 E. IMPERIAL HIGHWAY
LYNWOOD, CA
90262

Practice Phone: 310-900-8247
Practice Fax:

1942309331 — MARIA EDIT LOPEZ PA-C
Practice Location Address:

3590 E IMPERIAL HWY
LYNWOOD, CA
90262-2655

Practice Phone: 562-867-7999
Practice Fax: 310-438-2194

1366386096 — EVELYN MARINA CORTEZ
Practice Location Address:

3680 E IMPERIAL HWY STE 220
LYNWOOD, CA
90262-2663

Practice Phone: 323-769-7174
Practice Fax:

1144164104 — DENISSE MARIE HERNANDEZ
Practice Location Address:

3591 E IMPERIAL HWY
LYNWOOD, CA
90262-2654

Practice Phone: 866-733-5924
Practice Fax:

Directions to “PALO DIALYSIS LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.