1720114010 NPI number — HOME DIALYSIS THERAPIES OF SAN DIEGO

Table of content: CHRISTIN MARIE GIORDANO MCAULIFFE MD (NPI 1679894034)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720114010 NPI number — HOME DIALYSIS THERAPIES OF SAN DIEGO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOME DIALYSIS THERAPIES OF SAN DIEGO
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:
1720114010
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2060 OTAY LAKES RD
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
CHULA VISTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91915-1364
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-422-0003
Provider Business Mailing Address Fax Number:
619-422-0004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2060 OTAY LAKES RD
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91915-1364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-422-0003
Provider Business Practice Location Address Fax Number:
619-422-0004
Provider Enumeration Date:
02/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BARNES
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
858-549-3400

Provider Taxonomy Codes

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

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

  • Identifier: CDC552546F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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