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General NPI Number Information
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NPI Number | 1255961397
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Entity Type | Organization
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Legal Business Name | CENTRO DE CUIDADO RENAL, LLC
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Dates
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Enumeration Date | 01/16/2020
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Last Update Date | 05/19/2023
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Provider Practice Location Address
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Address Line | 5949 STATE ST
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-3139
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Country | US
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Telephone | 323-400-6595
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Fax |
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Provider Business Mailing Address
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Address Line | 5949 STATE ST
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-3139
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Country | US
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Telephone | 323-400-6595
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Fax |
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Authorized Official
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Title or Position | CORP SECRETARY
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Name | GUNDA JAHROMI
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Credential |
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Telephone | 323-400-6522
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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 |
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