HACIENDA DIALYSIS CENTER A MEDICAL CORP. NPI 1457342677

NPI Information

NPI: 1457342677
Provider Name: HACIENDA DIALYSIS CENTER, A MEDICAL CORP.
Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

CLIA Number: 05D0984608

Address:
2020 S HACIENDA BLVD
HACIENDA HEIGHTS, CA
ZIP 91745
Phone: (626) 968-9558
Get Directions

HACIENDA DIALYSIS CENTER, A MEDICAL CORP. is an end-stage renal disease (esrd) treatment clinic center in Hacienda Heights, CA. HACIENDA DIALYSIS CENTER, A MEDICAL CORP. NPI is 1457342677. The provider is registered as an organization entity type.

The provider's business location address is:

2020 S HACIENDA BLVD
HACIENDA HEIGHTS, CA
ZIP 91745-265
Phone: (626) 968-9558
Fax: (626) 968-7787

The provider's authorized official is Mary Shih .
The authorized official title is Administrator and has the following contact phone number (626) 968-9558.

The CLIA number assigned to this NPI record is 05D0984608 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/4/2005 and was last updated on 2/19/2008.

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
1	261QE0700X	Clinic/Center	End-Stage Renal Disease (ESRD) Treatment	930000972	CALIFORNIA	Yes

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
1	CDC02879F	MEDICAID	CALIFORNIA
2	052879	MEDICARE ID-TYPE UNSPECIFIED	CALIFORNIA	DIALYSIS CENTER

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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