Organization
FOUNTAIN VALLEY REGIONAL DIALYSIS CENTER LLC
Active
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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