Healthcare Provider Details

I. General information

NPI: 1861479040
Provider Name (Legal Business Name): RENAL CAREPARTNERS OF DAVIE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4970 SW 52ND ST 325
DAVIE FL
33314-5531
US

IV. Provider business mailing address

14361 COMMERCE WAY 306
MIAMI LAKES FL
33016-1565
US

V. Phone/Fax

Practice location:
  • Phone: 305-512-0014
  • Fax:
Mailing address:
  • Phone: 305-512-0014
  • Fax:

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: ORESTES LUGO
Title or Position: VP, CFO
Credential:
Phone: 305-512-0014