Healthcare Provider Details

I. General information

NPI: 1912860941
Provider Name (Legal Business Name): MOBILE DIALYSIS SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12804 EAGLES ENTRY DR
ODESSA FL
33556-2837
US

IV. Provider business mailing address

14910 N DALE MABRY HWY UNIT 340526
TAMPA FL
33618-1814
US

V. Phone/Fax

Practice location:
  • Phone: 813-786-0133
  • Fax:
Mailing address:
  • Phone: 813-786-0133
  • 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: OLAOLU ODEWOLE
Title or Position: PRESIDENT
Credential:
Phone: 415-200-7986