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NPI Code Detail

MEDICARE: NEPHRON DIALYSIS CENTER OF LAKEWOOD LLC

MEDICARE: NEPHRON DIALYSIS CENTER OF LAKEWOOD 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
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center930000886CA

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 : 1649298530
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEPHRON DIALYSIS CENTER OF LAKEWOOD LLC
Provider Business Mailing Address
First Line : 3356 W. BALL ROAD
Second Line : SUITE 216
City : ANAHEIM
State : CA
Zip : 92804-3702
Country : US
Telephone Number : 714-226-0818
Fax Number : 714-226-0700
Provider Business Practice Location Address
First Line : 5820 DOWNEY AVENUE
Second Line :
City : LONG BEACH
State : CA
Zip : 90805-4517
Country : US
Telephone Number : 562-663-0788
Fax Number : 562-663-0794
Authorized Official
Title or Position : PRESIDENT/CEO
Name : DR. GADSALLI RAMASWAMY RAVIKUMAR
Credential : M.D
Telephone Number : 714-226-0818
Provider Enumeration Date : 07/18/2006
Last Update Date : 11/27/2012

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Directions to “NEPHRON DIALYSIS CENTER OF LAKEWOOD LLC ” Practice Location

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