MEDICARE: CENTRO DE CUIDADO RENAL-ELA, LLC

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

General Provider Information

NPI Number	:	1487301297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRO DE CUIDADO RENAL-ELA, LLC

Provider Business Mailing Address
First Line	:	3575 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-1709
Country	:	US
Telephone Number	:	323-400-6522
Fax Number	:

Provider Business Practice Location Address
First Line	:	3575 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-1709
Country	:	US
Telephone Number	:	323-400-6522
Fax Number	:

Authorized Official
Title or Position	:	CORP SECRETARY
Name	:	GUNDA JAHROMI
Credential	:
Telephone Number	:	323-400-6522

Provider Enumeration Date	:	03/02/2022
Last Update Date	:	05/19/2023

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