Healthcare Provider Details

I. General information

NPI: 1205835147
Provider Name (Legal Business Name): HEMODIALYSIS,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 S FAIR OAKS AVE
PASADENA CA
91105-2601
US

IV. Provider business mailing address

710 W WILSON AVE
GLENDALE CA
91203-2409
US

V. Phone/Fax

Practice location:
  • Phone: 626-792-0548
  • Fax:
Mailing address:
  • Phone: 818-500-8736
  • Fax: 818-500-7214

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: DR. JOHN R DE PALMA
Title or Position: C.E.O./PRESIDENT
Credential: M.D.
Phone: 818-500-8736