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NPI Code Detail

MEDICARE: DAVITA CKD DIETITIANS, LLC

MEDICARE: DAVITA CKD DIETITIANS, 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
1133V00000XRegistered Dietitian1018836CO

General Provider Information

NPI Number : 1871956276
Entity Type Code : Organization
Provider Name (Legal Business Name) : DAVITA CKD DIETITIANS, LLC
Provider Business Mailing Address
First Line : 601 HAWAII ST
Second Line : JLD/SECGOVFIN
City : EL SEGUNDO
State : CA
Zip : 90245-4814
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2000 16TH ST
Second Line : JLD/SECGOVFIN
City : DENVER
State : CO
Zip : 80202-5117
Country : US
Telephone Number : 303-876-6438
Fax Number :
Authorized Official
Title or Position : MANAGER OF SPECIAL PROJECTS
Name : ALLISON MANICHE
Credential :
Telephone Number : 303-941-7463
Provider Enumeration Date : 04/01/2016
Last Update Date : 04/01/2016

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Directions to “DAVITA CKD DIETITIANS, LLC ” Practice Location

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