1194170852 NPI number — PERITONEAL DIALYSIS CENTER INC.

Table of content: ELENA GARCIA QUEZADA LVN (NPI 1144068586)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194170852 NPI number — PERITONEAL DIALYSIS CENTER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERITONEAL DIALYSIS CENTER INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194170852
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 EAST SAMPLE ROAD
Provider Second Line Business Mailing Address:
SUITE 301A
Provider Business Mailing Address City Name:
POMPANO BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33064-3552
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-709-9793
Provider Business Mailing Address Fax Number:
888-349-8679

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
714 W 51ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33140-2615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-709-9793
Provider Business Practice Location Address Fax Number:
888-349-8679
Provider Enumeration Date:
05/02/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SANTOS
Authorized Official First Name:
MARCIA
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
954-709-9793

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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