1033151816 NPI number — KIDNEY DIALYSIS CENTER OF SAN LUIS OBISPO,LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033151816 NPI number — KIDNEY DIALYSIS CENTER OF SAN LUIS OBISPO,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIDNEY DIALYSIS CENTER OF SAN LUIS OBISPO,LLC
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:
1033151816
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 940838
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIMI VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93094-0838
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-443-7777
Provider Business Mailing Address Fax Number:
805-433-7655

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1043 MARSH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN LUIS OBISPO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93401-3629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-543-1013
Provider Business Practice Location Address Fax Number:
805-543-5654
Provider Enumeration Date:
06/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
UPPONI
Authorized Official First Name:
LISA
Authorized Official Middle Name:
VIRAL
Authorized Official Title or Position:
DIRECTOR OF ACCOUNTS RECEIVABLE
Authorized Official Telephone Number:
805-433-7506

Provider Taxonomy Codes

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

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

  • Identifier: ZZZ02842Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CDC02811G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com