Organization
DAVITA RIVERSIDE II LLC
Active
Other names
Magnolia West 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
11161 MAGNOLIA AVE, RIVERSIDE, CA 92505-3605
(951) 351-8090
(951) 351-8099
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
550000177
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316971641
—
CA
Enumeration date
07/11/2006
Last updated
04/04/2024
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