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General NPI Number Information
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NPI Number | 1265403976
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Entity Type | Organization
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Legal Business Name | OAKDALE KIDNEY CENTER LLC
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 4 WILLOW GLEN AVE
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City | OAKDALE
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State | CA
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Zip | 95361-3319
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Country | US
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Telephone | 209-848-5780
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Fax | 209-848-5789
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Provider Business Mailing Address
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Address Line | 4 WILLOW GLEN AVE
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City | OAKDALE
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State | CA
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Zip | 95361
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Country | US
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Telephone | 209-848-5780
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Fax | 209-848-5789
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MR. THOMAS L. WEINBERG
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Credential |
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Telephone | 214-736-2700
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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 | 110000477
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License Number State | CA
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