Healthcare Provider Details

I. General information

NPI: 1245344654
Provider Name (Legal Business Name): BALDWIN HILLS DIALYSIS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 S. LABREA AVE.
LOS ANGELES CA
90016
US

IV. Provider business mailing address

3705 S LA BREA AVE
LOS ANGELES CA
90016-5309
US

V. Phone/Fax

Practice location:
  • Phone: 323-293-4488
  • Fax: 323-293-4499
Mailing address:
  • Phone: 323-293-4488
  • Fax: 323-293-4499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number930000904
License Number StateCA

VIII. Authorized Official

Name: DR. RICHARD S. HOROWITZ
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 323-293-4488