MEDICARE: DVA RENAL HEALTHCARE INC

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	080000759	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	:	1568437978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DVA RENAL HEALTHCARE INC

Provider Business Mailing Address
First Line	:	5200 VIRGINIA WAY
Second Line	:	L&C DEPT
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7569
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	292 EUCLID AVE STE 100
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92114-3629
Country	:	US
Telephone Number	:	619-262-7225
Fax Number	:	619-262-7470

Authorized Official
Title or Position	:	VP, LICENSURE & CERTIFICATION
Name	:	SAMUEL T. WEY
Credential	:
Telephone Number	:	615-341-6641

Provider Enumeration Date	:	02/20/2006
Last Update Date	:	11/12/2025

Similar Medicare Providers

1881914000 — GRUPO MEDICO POLICLINICA SAN PEDRO MEDICARE ADVANTAGE
Practice Location Address:

211 CALLE MORSE
ARROYO, PR
00714-2350

Practice Phone: 787-839-3980
Practice Fax: 787-271-2515

1205881398 — CARLTON WAYNE THOMAS JR. M.D.
Practice Location Address:

292 EUCLID AVE STE 115
SAN DIEGO, CA
92114-3629

Practice Phone: 619-266-3332
Practice Fax: 619-266-6000

1649373739 — DR. ELI MARRETTE WATTS MD
Practice Location Address:

292 EUCLID AVE STE 210
SAN DIEGO, CA
92114-3629

Practice Phone: 619-662-4100
Practice Fax: 619-579-2921

1518086388 — MRS. YVONNE DECASTRO FERMIL FNP
Practice Location Address:

292 EUCLID AVE STE 115
SAN DIEGO, CA
92114-3629

Practice Phone: 619-266-3332
Practice Fax:

1619262664 — DR. ASHVIN B SHENOY M.D.
Practice Location Address:

292 EUCLID AVE , SUITE 220
SAN DIEGO, CA
92114-3629

Practice Phone: 619-262-8624
Practice Fax: 619-262-6639

1730477621 — ELIZABETH J. WATERS M.D.
Practice Location Address:

292 EUCLID AVE , SUITE 220
SAN DIEGO, CA
92114-3629

Practice Phone: 619-262-8624
Practice Fax: 619-262-6639

Directions to “DVA RENAL HEALTHCARE INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.