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General NPI Number Information
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NPI Number | 1700148632
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL DIALYSIS CENTER, LLC
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Dates
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Enumeration Date | 06/15/2012
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Last Update Date | 09/18/2013
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Provider Practice Location Address
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Address Line | 10021 PINES BLVD SUITE 201
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6194
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Country | US
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Telephone | 954-417-1070
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Fax | 954-417-1071
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Provider Business Mailing Address
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Address Line | 10021 PINES BLVD SUITE 201
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6194
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Country | US
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Telephone | 954-417-1070
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Fax | 954-417-1071
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Authorized Official
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Title or Position | CEO
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Name | MR. JULIO C MOLINA
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Credential |
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Telephone | 954-417-1070
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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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