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NPI Code Detail

MEDICARE: FLORENCE DIALYSIS CENTER

MEDICARE: FLORENCE 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
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/CenterCA

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 : 1780676957
Entity Type Code : Organization
Provider Name (Legal Business Name) : FLORENCE 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 : 351 W FLORENCE AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90003-1808
Country : US
Telephone Number : 323-789-5690
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR
Name : MALCOM EYMAN
Credential :
Telephone Number : 562-598-2173
Provider Enumeration Date : 08/15/2005
Last Update Date : 08/22/2020

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Directions to “FLORENCE DIALYSIS CENTER ” Practice Location

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