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General NPI Number Information
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NPI Number | 1780907600
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Entity Type | Organization
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Legal Business Name | PENINSULA DIALYSIS ACCESS, LLC
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Dates
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Enumeration Date | 03/05/2010
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Last Update Date | 03/05/2010
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Provider Practice Location Address
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Address Line | 91 WESTBOROUGH BLVD STE. 2010
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City | SOUTH SAN FRANCISCO
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State | CA
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Zip | 94080-3162
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Country | US
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Telephone | 650-871-2449
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Fax |
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Provider Business Mailing Address
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Address Line | 864 S WOODLAND ST
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City | ORANGE
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State | CA
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Zip | 92869-5229
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Country | US
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Telephone | 714-404-6855
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. CYNTHIA M JANSEN
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Credential |
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Telephone | 714-404-6855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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