MEDICARE: SOUTH VALLEY REGIONAL DIALYSIS CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center		CA

General Provider Information

NPI Number	:	1073517967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH VALLEY REGIONAL DIALYSIS CENTER INC

Provider Business Mailing Address
First Line	:	17815 VENTURA BLVD
Second Line	:	STE 100
City	:	ENCINO
State	:	CA
Zip	:	91316-3610
Country	:	US
Telephone Number	:	818-705-7219
Fax Number	:

Provider Business Practice Location Address
First Line	:	17815 VENTURA BLVD
Second Line	:	STE 100
City	:	ENCINO
State	:	CA
Zip	:	91316-3600
Country	:	US
Telephone Number	:	818-757-4520
Fax Number	:	818-757-1043

Authorized Official
Title or Position	:	SR VICE PRESIDENT
Name	:	SUE VOGEL JR.
Credential	:
Telephone Number	:	770-541-7922

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	08/22/2020

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