MEDICARE: BALDWIN HILLS DIALYSIS CENTER

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	930000904	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	ZZZ57405Z	OTHER	CA	BLUE SHIELD OF CALIFORNIA

General Provider Information

NPI Number	:	1245344654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALDWIN HILLS DIALYSIS CENTER

Provider Business Mailing Address
First Line	:	3705 S LA BREA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-5309
Country	:	US
Telephone Number	:	323-293-4488
Fax Number	:	323-293-4499

Provider Business Practice Location Address
First Line	:	3705 S. LABREA AVE.
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016
Country	:	US
Telephone Number	:	323-293-4488
Fax Number	:	323-293-4499

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. RICHARD S. HOROWITZ
Credential	:	M.D.
Telephone Number	:	323-293-4488

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	04/07/2011

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Directions to “BALDWIN HILLS DIALYSIS CENTER ” Practice Location

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