Organization
DVA RENAL HEALTHCARE INC
Active
Other names
Santa Monica Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T. WEY (VP, LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
1260 15TH ST, STE 102, SANTA MONICA, CA 90404-1136
(310) 393-4744
(310) 393-5308
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
930000429
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144295163
—
CA
Enumeration date
02/22/2006
Last updated
09/16/2024
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