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General NPI Number Information
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NPI Number | 1255342861
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Entity Type | Organization
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Legal Business Name | CITRUS DIALYSIS CENTER, INC.
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 315 N 3RD AVE SUITE 104
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City | COVINA
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State | CA
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Zip | 91723-1905
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Country | US
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Telephone | 626-331-0133
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Fax | 626-331-6649
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Provider Business Mailing Address
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Address Line | 1335 CYPRESS STREET SUITE 207
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City | SAND DIMAS
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State | CA
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Zip | 91773-3537
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Country | US
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Telephone | 909-542-2900
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Fax | 909-549-2600
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MOJTABA MOGHADAM
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Credential | M.D.
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Telephone | 909-542-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State | CA
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