DAVITA RIVERSIDE LLC NPI 1205895869

NPI Information

  • NPI: 1205895869
  • Provider Name: DAVITA RIVERSIDE LLC
  • Classification: Clinic/Center - 261QE0700X
  • Specialization: End-Stage Renal Disease (ESRD) Treatment
  • Entity Type: Organization
  • Doing Business As: LAKE ELSINORE DIALYSIS
  • CLIA Number: 05D1000652
  • Address: 32291 MISSION TRL
    BLDG S
    LAKE ELSINORE, CA
    ZIP 92530
  • Phone: (951) 674-5050

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NPI Details

DAVITA RIVERSIDE LLC is an end-stage renal disease (esrd) treatment clinic center in Lake Elsinore, CA. DAVITA RIVERSIDE LLC NPI is 1205895869. The provider is registered as an organization entity type.
The provider Is Doing Business As Lake Elsinore Dialysis.

The provider's business location address is:

32291 MISSION TRL
BLDG S
LAKE ELSINORE, CA
ZIP 92530-310
Phone: (951) 674-5050
Fax: (951) 674-5570

The provider's authorized official is Samuel T. Wey .
The authorized official title is Vp, Licensure & Certification and has the following contact phone number (615) 341-6641.

The CLIA number assigned to this NPI record is 05D1000652 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/22/2006 and was last updated on 12/24/2024.

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) Treatment240000841CALIFORNIAYes

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
11205895869MEDICAIDCALIFORNIA

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: 3/30/2025

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