Healthcare Provider Details

I. General information

NPI: 1588214738
Provider Name (Legal Business Name): HSRENAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2019
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16925 BELLFLOWER BLVD
BELLFLOWER CA
90706-5903
US

IV. Provider business mailing address

16925 BELLFLOWER BLVD
BELLFLOWER CA
90706-5903
US

V. Phone/Fax

Practice location:
  • Phone: 714-323-5157
  • Fax:
Mailing address:
  • Phone: 714-323-5157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2472R0900X
TaxonomyRenal Dialysis Technician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL LEE
Title or Position: PRESIDENT
Credential:
Phone: 714-323-5157