Organization
DVA RENAL HEALTHCARE INC
Active
Other names
San Diego South Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T. WEY SR. (VP, LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
995 GATEWAY CENTER WAY, STE 101, SAN DIEGO, CA 92102-4550
(619) 262-1960
(619) 262-2420
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 238-3085
(800) 268-9682
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
080000705
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093780017
—
CA
05
—
1791954
—
LA
Enumeration date
02/22/2006
Last updated
01/16/2024
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