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General NPI Number Information
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NPI Number | 1598197055
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Entity Type | Organization
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Legal Business Name | TOTAL RENAL CARE
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Dates
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Enumeration Date | 08/06/2013
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Last Update Date | 08/06/2013
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Provider Practice Location Address
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Address Line | 1936 E 1ST ST
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City | LOS ANGELES
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State | CA
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Zip | 90033-3413
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Country | US
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Telephone | 323-268-2729
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Fax |
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Provider Business Mailing Address
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Address Line | 1936 E 1ST ST
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City | LOS ANGELES
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State | CA
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Zip | 90033-3413
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Country | US
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Telephone | 323-268-2729
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Fax |
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Authorized Official
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Title or Position | FACILITY ADMINISTRATOR
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Name | HALEY MEHREN
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Credential | RN
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Telephone | 323-268-2729
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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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