MEDICARE: ST. JOSEPH SATELLITE DIALYSIS CENTERS, 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
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center		CA

General Provider Information

NPI Number	:	1790229318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. JOSEPH SATELLITE DIALYSIS CENTERS, LLC

Provider Business Mailing Address
First Line	:	1518 W LA VETA AVE
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92868-4117
Country	:	US
Telephone Number	:	714-285-9675
Fax Number	:	714-285-9681

Provider Business Practice Location Address
First Line	:	1518 W LA VETA AVE
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92868-4117
Country	:	US
Telephone Number	:	714-285-9675
Fax Number	:	714-285-9681

Authorized Official
Title or Position	:	CHAIRMAN
Name	:	THOMAS L WEINBERG
Credential	:
Telephone Number	:	214-736-2700

Provider Enumeration Date	:	12/16/2016
Last Update Date	:	04/23/2024

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