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NPI Code Detail

MEDICARE: HACIENDA DIALYSIS CENTER, A MEDICAL CORP.

MEDICARE: HACIENDA DIALYSIS CENTER, A MEDICAL CORP.
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
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center930000972CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457342677
Entity Type Code : Organization
Provider Name (Legal Business Name) : HACIENDA DIALYSIS CENTER, A MEDICAL CORP.
Provider Business Mailing Address
First Line : 2020 S HACIENDA BLVD
Second Line :
City : HACIENDA HEIGHTS
State : CA
Zip : 91745-4265
Country : US
Telephone Number : 626-968-9558
Fax Number : 626-968-7787
Provider Business Practice Location Address
First Line : 2020 S HACIENDA BLVD
Second Line :
City : HACIENDA HEIGHTS
State : CA
Zip : 91745-4265
Country : US
Telephone Number : 626-968-9558
Fax Number : 626-968-7787
Authorized Official
Title or Position : ADMINISTRATOR
Name : MRS. MARY SHIH
Credential :
Telephone Number : 626-968-9558
Provider Enumeration Date : 11/04/2005
Last Update Date : 02/19/2008

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