Healthcare Provider Details

I. General information

NPI: 1881686053
Provider Name (Legal Business Name): MOBILE DIALYSIS SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W COMPTON BLVD
COMPTON CA
90220-2924
US

IV. Provider business mailing address

3810 KATELLA AVE
LOS ALAMITOS CA
90720-3302
US

V. Phone/Fax

Practice location:
  • Phone: 310-637-9026
  • Fax:
Mailing address:
  • Phone: 562-598-9399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: JACKIE SUAREZ
Title or Position: SUPERVISOR
Credential:
Phone: 562-598-2705