Healthcare Provider Details

I. General information

NPI: 1316761943
Provider Name (Legal Business Name): ROCKY MOUNTAIN KIDNEY CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S EL CAMINO REAL FL 1
SAN MATEO CA
94403-1805
US

IV. Provider business mailing address

5851 LEGACY CIR STE 900
PLANO TX
75024-5982
US

V. Phone/Fax

Practice location:
  • Phone: 888-288-5977
  • Fax: 833-428-7023
Mailing address:
  • Phone: 469-590-5955
  • Fax: 469-833-4858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARY DITTRICH
Title or Position: OWNER
Credential: MD
Phone: 469-590-5955