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WELLBOUND OF MENLO PARK LLC NPI 1417229022


NPI Information

NPI: 1417229022
Provider Name: WELLBOUND OF MENLO PARK LLC

Doing Business As: WELLBOUND OF DALY CITY

Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

CLIA Number: 05D2048405

Address:
2001 JUNIPERO SERRA BLVD
SUITE 535
DALY CITY, CA
ZIP 94014
Phone: (650) 550-3600
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WELLBOUND OF MENLO PARK LLC is an end-stage renal disease (esrd) treatment clinic center in Daly City, CA. WELLBOUND OF MENLO PARK LLC NPI is 1417229022. The provider is registered as an organization entity type.
The provider Is Doing Business As Wellbound Of Daly City.

The provider's business location address is:

2001 JUNIPERO SERRA BLVD
SUITE 535
DALY CITY, CA
ZIP 94014-891
Phone: (650) 550-3600
Fax: (650) 991-3125

The provider's authorized official is Bernadette Vincent .
The authorized official title is President/coo and has the following contact phone number (650) 404-3600.

The CLIA number assigned to this NPI record is 05D2048405 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/30/2012 and was last updated on 4/12/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QE0700XClinic/CenterEnd-Stage Renal Disease (ESRD) TreatmentYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11417229022MEDICAIDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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