Healthcare Provider Details

I. General information

NPI: 1922630706
Provider Name (Legal Business Name): AQUA DIALYSIS LIVINGSTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2020
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 W PARK
LIVINGSTON TX
77351-7020
US

IV. Provider business mailing address

1245 SOUTHRIDGE CT STE 102
HURST TX
76053-4390
US

V. Phone/Fax

Practice location:
  • Phone: 936-327-1108
  • Fax: 936-327-1135
Mailing address:
  • Phone: 682-429-4508
  • Fax: 346-214-6368

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: RUPAL PATEL
Title or Position: CEO
Credential: MD
Phone: 832-721-2927