Healthcare Provider Details

I. General information

NPI: 1699852327
Provider Name (Legal Business Name): DIALYSIS ACCESS CENTER A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3012 SUMMIT ST D WING
OAKLAND CA
94609-3480
US

IV. Provider business mailing address

PO BOX 883528
LOS ANGELES CA
90088-3528
US

V. Phone/Fax

Practice location:
  • Phone: 510-251-1002
  • Fax: 510-251-1034
Mailing address:
  • Phone: 510-251-1002
  • Fax: 510-251-1034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS TURNER
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 510-251-1002