Organization
DVA RENAL HEALTHCARE INC
Active
Other names
San Juan Capistrano South 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
31736 RANCHO VIEJO RD STE D, SAN JUAN CAPISTRANO, CA 92675-2783
(949) 240-1454
(949) 240-0735
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
080000680
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447226204
—
CA
Enumeration date
02/23/2006
Last updated
11/12/2025
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