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General NPI Number Information
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NPI Number | 1811180904
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Entity Type | Organization
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Legal Business Name | MESQUITE DIALYSIS CENTER LLC
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Dates
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Enumeration Date | 08/22/2007
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Last Update Date | 08/22/2007
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Provider Practice Location Address
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Address Line | 330 FALCON RIDGE PKWY STE 400
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City | MESQUITE
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State | NV
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Zip | 89027-8881
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Country | US
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Telephone | 702-274-3630
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Fax |
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Provider Business Mailing Address
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Address Line | 807 CANYON GREENS DR
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City | LAS VEGAS
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State | NV
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Zip | 89144-0836
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Country | US
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Telephone | 702-274-3630
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RAM JANGA
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Credential |
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Telephone | 702-274-3630
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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 | PENDING
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License Number State | NV
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