WALTON DIALYSIS LLC NPI 1063838894

NPI Information

NPI: 1063838894
Provider Name: WALTON DIALYSIS LLC

Doing Business As: COLTON RANCH DIALYSIS

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

Specialization: End-Stage Renal Disease (ESRD) Treatment

CLIA Number: 05D2081158

Address:
1405 W VALLEY BLVD
STE 100
COLTON, CA
ZIP 92324
Phone: (909) 783-7948
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WALTON DIALYSIS LLC is an end-stage renal disease (esrd) treatment clinic center in Colton, CA. WALTON DIALYSIS LLC NPI is 1063838894. The provider is registered as an organization entity type.
The provider Is Doing Business As Colton Ranch Dialysis.

The provider's business location address is:

1405 W VALLEY BLVD
STE 100
COLTON, CA
ZIP 92324-963
Phone: (909) 783-7948
Fax: (909) 783-0125

The provider's authorized official is John D Winstel .
The authorized official title is Chief Accounting Officer and has the following contact phone number (253) 733-4501.

The CLIA number assigned to this NPI record is 05D2081158 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/18/2014 and was last updated on 9/23/2022.

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	550002975	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	1063838894	MEDICAID	CALIFORNIA

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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