Healthcare Provider Details

I. General information

NPI: 1063763159
Provider Name (Legal Business Name): ALL ACCESS MOBILE HEMODIALYSIS,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2012
Last Update Date: 01/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 OPAL HILL CIR
DAYTONA BEACH FL
32124-2018
US

IV. Provider business mailing address

PO BOX 11434
DAYTONA BEACH FL
32120-1434
US

V. Phone/Fax

Practice location:
  • Phone: 800-381-7639
  • Fax: 800-381-7639
Mailing address:
  • Phone: 800-381-7639
  • Fax: 800-381-7639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2472R0900X
TaxonomyRenal Dialysis Technician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1612642
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN1612642
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License NumberRN1612642
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN1612642
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License NumberRN1612642
License Number StateFL
# 9
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License NumberRN1612642
License Number StateFL
# 10
Primary TaxonomyN
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License NumberRN1612642
License Number StateFL
# 11
Primary TaxonomyY
Taxonomy Code163WH0500X
TaxonomyHemodialysis Registered Nurse
License NumberRN1612642
License Number StateFL

VIII. Authorized Official

Name: MR. ROBERTO DONALD BARRAGAN III
Title or Position: CEO
Credential:
Phone: 800-381-7639