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General NPI Number Information
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NPI Number | 1568172484
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Entity Type | Organization
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Legal Business Name | RANCHO DIALYSIS CENTER INC
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Dates
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Enumeration Date | 12/01/2022
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Last Update Date | 12/01/2022
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Provider Practice Location Address
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Address Line | 7777 MILLIKEN AVE
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-6780
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Country | US
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Telephone | 909-542-2898
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Fax |
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Provider Business Mailing Address
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Address Line | 1335 CYPRESS ST STE 207
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City | SAN DIMAS
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State | CA
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Zip | 91773-3539
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Country | US
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Telephone | 909-542-2898
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | GINA LYNN MONTE
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Credential |
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Telephone | 909-542-2898
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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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