MEDICARE: DR 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	:	1790507879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR DIALYSIS LLC

Provider Business Mailing Address
First Line	:	1680 NE 164TH ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4017
Country	:	US
Telephone Number	:	305-749-6774
Fax Number	:	305-749-6869

Provider Business Practice Location Address
First Line	:	1680 NE 164TH ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4017
Country	:	US
Telephone Number	:	305-749-6774
Fax Number	:	305-749-6869

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	DALY RODRIGUEZ DURAN
Credential	:
Telephone Number	:	786-445-3311

Provider Enumeration Date	:	10/29/2024
Last Update Date	:	11/01/2024

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