1730190331 NPI number — LA PUENTE DIALYSIS CENTER, INC.

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 1730190331 NPI number — LA PUENTE DIALYSIS CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LA PUENTE 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:
1730190331
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1335 CYPRESS STREET
Provider Second Line Business Mailing Address:
SUITE 207
Provider Business Mailing Address City Name:
SAN DIMAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91773-3537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-542-2900
Provider Business Mailing Address Fax Number:
909-592-6000

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14557 TEMPLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA PUENTE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91744-3492
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-917-1719
Provider Business Practice Location Address Fax Number:
626-917-2917
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RIZVI
Authorized Official First Name:
SYED ARIF
Authorized Official Middle Name:
ALI
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
909-542-2900

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  930000458 , 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)





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