Healthcare Provider Details

I. General information

NPI: 1457510919
Provider Name (Legal Business Name): SATELLITE DIALYSIS OF TRACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2156 W GRANT LINE RD SUITE 150
TRACY CA
95377-7338
US

IV. Provider business mailing address

300 SANTANA ROW SUITE 300
SAN JOSE CA
95128-2423
US

V. Phone/Fax

Practice location:
  • Phone: 209-832-4899
  • Fax: 209-832-4893
Mailing address:
  • Phone: 209-832-4899
  • Fax: 650-625-6007

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 State

VIII. Authorized Official

Name: THOMAS L WEINBERG
Title or Position: CHAIRMAN
Credential:
Phone: 214-736-2700