03D1057554 CLIA NUMBER - SOUTHWEST KIDNEY-DAVITA DIALYSIS PARTNER, LLC DBA ESTRELLA DIALYSIS CENTER

Laboratory Demographics

CLIA Number: 03D1057554

Facility Name: SOUTHWEST KIDNEY-DAVITA DIALYSIS PARTNER, LLC DBA ESTRELLA DIALYSIS CENTER

Facility Address:
8410 W THOMAS RD, BLDG 1, STE 100
PHOENIX, AZ
ZIP 85037
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Facility Phone Number: 623 247-0808

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1518973932

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	03D1057554
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	SOUTHWEST KIDNEY-DAVITA DIALYSIS PARTNER, LLC DBA ESTRELLA DIALYSIS CENTER
Street	8410 W THOMAS RD, BLDG 1, STE 100
City	PHOENIX
State	AZ
ZIP	85037
Phone	623 247-0808
CertificateType	4
CertificateEffectiveDate	8/15/2022
CertificateExpirationDate	8/14/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024