CORAL DIALYSIS LLC NPI 1437569514

NPI Information

  • NPI: 1437569514
  • Provider Name: CORAL DIALYSIS LLC
  • Classification: Clinic/Center - 261QE0700X
  • Specialization: End-Stage Renal Disease (ESRD) Treatment
  • Entity Type: Organization
  • Doing Business As: PORT CITY DIALYSIS
  • CLIA Number: 05D2086215
  • Address: 1810 S FRESNO AVE
    STOCKTON, CA
    ZIP 95206
  • Phone: (209) 946-0738

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NPI Details

CORAL DIALYSIS LLC is an end-stage renal disease (esrd) treatment clinic center in Stockton, CA. CORAL DIALYSIS LLC NPI is 1437569514. The provider is registered as an organization entity type.
The provider Is Doing Business As Port City Dialysis.

The provider's business location address is:

1810 S FRESNO AVE
STOCKTON, CA
ZIP 95206-861
Phone: (209) 946-0738
Fax: (209) 946-0827

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 05D2086215 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/29/2014 and was last updated on 9/20/2024.

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) 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
11437569514MEDICAIDCALIFORNIA

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: 11/21/2025

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