MEDICARE: MORENO VALLEY 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		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

General Provider Information

NPI Number	:	1518959774
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MORENO VALLEY DIALYSIS CENTER

Provider Business Mailing Address
First Line	:	3810 KATELLA AVE
Second Line	:
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-3302
Country	:	US
Telephone Number	:	562-598-9399
Fax Number	:

Provider Business Practice Location Address
First Line	:	22620 GOLDENCREST DR
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92553-9032
Country	:	US
Telephone Number	:	951-656-3804
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MAHER AZER
Credential	:	M.D.
Telephone Number	:	562-598-2173

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	08/22/2020

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