Healthcare Provider Details

I. General information

NPI: 1528047909
Provider Name (Legal Business Name): BOCA/DELRAY RENAL ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 CLINT MOORE RD SUITE 306
BOCA RATON FL
33496-2658
US

IV. Provider business mailing address

1905 CLINT MOORE RD SUITE 306
BOCA RATON FL
33496-2658
US

V. Phone/Fax

Practice location:
  • Phone: 561-988-7100
  • Fax: 561-988-6120
Mailing address:
  • Phone: 561-988-7100
  • Fax: 561-988-6120

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: FRANCES L KRAUSE
Title or Position: OFFICE MANAGER
Credential:
Phone: 561-988-7100