Organization
INTERCOMMUNITY DIALYSIS CENTER-LA MIRADA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DELORES GAYLE ROGERS LCSW (SOCIAL WORKER)
(562) 696-1841
Entity
Organization
Contact information
Practice address
15060 IMPERIAL HWY, LA MIRADA, CA 90638-1301
(562) 696-1841
Mailing address
PO BOX 6367, WHITTIER, CA 90609-6367
(562) 696-1841
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
12/12/2016
Last updated
12/12/2016
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