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General NPI Number Information
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NPI Number | 1346062999
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Entity Type | Organization
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Legal Business Name | PENINSULA DIALYSIS ACCESS CENTER
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Dates
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Enumeration Date | 10/25/2024
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 91 WESTBOROUGH BLVD STE 1010
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City | SOUTH SAN FRANCISCO
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State | CA
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Zip | 94080-3196
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Country | US
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Telephone | 408-410-9266
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Fax | 408-877-3786
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Provider Business Mailing Address
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Address Line | 91 WESTBOROUGH BLVD STE 1010
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City | SOUTH SAN FRANCISCO
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State | CA
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Zip | 94080-3196
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Country | US
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Telephone | 408-410-9266
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Fax | 408-877-3786
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MRS. CHRIS MCMAHON
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Credential |
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Telephone | 408-410-9266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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