Healthcare Provider Details

I. General information

NPI: 1467497941
Provider Name (Legal Business Name): KIDNEY DIALYSIS CENTER OF VENTURA,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 LOMA VISTA RD
VENTURA CA
93003-1581
US

IV. Provider business mailing address

PO BOX 940838
SIMI VALLEY CA
93094-0838
US

V. Phone/Fax

Practice location:
  • Phone: 805-433-7777
  • Fax: 805-433-7655
Mailing address:
  • Phone: 805-443-7777
  • Fax: 805-433-7655

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: MRS. LISA VIRAL UPPONI
Title or Position: DIRECTOR OF ACCOUNTS RECEIVABLE
Credential:
Phone: 805-433-7506