Organization
FOUNTAIN VALLEY REGIONAL DIALYSIS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GADSALLI RAMASWAMY RAVIKUMAR M.D. (PRESIDENT/CEO)
(714) 226-0818
Entity
Organization
Contact information
Practice address
17150 EUCLID AVENUE, SUITE 111, FOUNTAIN VALLEY, CA 92708-4092
(714) 966-1595
(714) 966-1555
Mailing address
3356 W BALL RD, SUITE 216, ANAHEIM, CA 92804-3702
(714) 226-0818
(714) 226-0700
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
550001163
CA
Other
Enumeration date
05/30/2007
Last updated
11/27/2012
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