Organization
SATELLITE DIALYSIS OF LYNWOOD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARGARITA GUIZAR (COMPLIANCE & RISK DIRECTOR)
(650) 404-3771
Entity
Organization
Contact information
Practice address
8716 GARFIELD AVE, STE 100, SOUTH GATE, CA 90280-3723
(562) 674-2600
(562) 928-9304
Mailing address
300 SANTANA ROW, SUITE 300, SAN JOSE, CA 95128-2423
(562) 674-2600
(650) 625-6007
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D2020393
CLIA CERTIFICATE OF WAIVER
CA
05
—
1376859108
—
CA
01
—
550001699
STATE LICENSE
CA
Enumeration date
08/31/2010
Last updated
04/29/2020
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