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General NPI Number Information
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NPI Number | 1538648407
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Entity Type | Organization
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Legal Business Name | KIDNEY DOCTORS DIALYSIS CENTER INC
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Dates
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Enumeration Date | 08/10/2018
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Last Update Date | 05/26/2022
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Provider Practice Location Address
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Address Line | 12145 PEMBROKE RD
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City | PEMBROKE PINES
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State | FL
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Zip | 33025-1727
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Country | US
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Telephone | 954-743-5804
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Fax | 954-743-4747
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Provider Business Mailing Address
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Address Line | 12145 PEMBROKE RD
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City | PEMBROKE PINES
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State | FL
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Zip | 33025-1727
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Country | US
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Telephone | 954-743-5804
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Fax | 954-743-4747
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Authorized Official
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Title or Position | DIRECTOR/ADMINISTRATOR/DON
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Name | MR. FRANCISCO JOSE BERNAL PEREZ
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Credential | ARNP, FNP-C
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Telephone | 786-365-6624
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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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