MEDICARE: EAST LA 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	:	1528105293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST LA 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	:	562-426-8881
Fax Number	:

Provider Business Practice Location Address
First Line	:	5830 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-4302
Country	:	US
Telephone Number	:	323-887-8545
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. MAHER A. AZER
Credential	:	MD
Telephone Number	:	562-426-8881

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	08/22/2020

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Directions to “EAST LA DIALYSIS CENTER ” Practice Location

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