Healthcare Provider Details

I. General information

NPI: 1700029642
Provider Name (Legal Business Name): PALOMAR DIALYSIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 DOOLAN RD STE 175
LIVERMORE CA
94551-9610
US

IV. Provider business mailing address

5200 VIRGINIA WAY L & C DEPT
BRENTWOOD TN
37027-7569
US

V. Phone/Fax

Practice location:
  • Phone: 925-245-9780
  • Fax: 925-245-9785
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number5500001188
License Number StateCA

VIII. Authorized Official

Name: SAMUEL T. WEY
Title or Position: VP LICENSURE & CERTIFICATION
Credential:
Phone: 615-341-6641