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General NPI Number Information
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NPI Number | 1750495669
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Entity Type | Organization
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Legal Business Name | PERITONEAL DIALYSIS CENTER OF AMERICA, INC
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 3112 W BEVERLY BLVD
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City | MONTEBELLO
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State | CA
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Zip | 90640-2217
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Country | US
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Telephone | 323-722-2053
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Fax | 323-722-2063
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Provider Business Mailing Address
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Address Line | 3112 W BEVERLY BLVD
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City | MONTEBELLO
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State | CA
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Zip | 90640-2217
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Country | US
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Telephone | 323-722-2053
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Fax | 323-722-2063
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | PRADIP CP CHOWDHURY
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Credential | MD
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Telephone | 323-371-4182
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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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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