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General NPI Number Information
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NPI Number | 1538429451
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Entity Type | Organization
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Legal Business Name | MEMORIAL PERITONEAL DIALYSIS LLC
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Dates
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Enumeration Date | 05/24/2012
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Last Update Date | 05/24/2012
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Provider Practice Location Address
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Address Line | 1170 BLALOCK RD
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City | HOUSTON
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State | TX
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Zip | 77055-7421
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Country | US
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Telephone | 909-450-7159
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Fax |
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Provider Business Mailing Address
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Address Line | 1170 BLALOCK RD
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City | HOUSTON
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State | TX
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Zip | 77055-7421
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Country | US
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Telephone | 909-450-7159
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ELVA AGRA
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Credential |
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Telephone | 909-450-7159
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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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