Organization
RAI CARE CENTERS OF SOUTHERN CALIFORNIA II, LLC
Active
Other names
RAI-Broadway-Chula Vista
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JON M SUNDOCK (VICE PRESIDENT)
(615) 507-3307
Entity
Organization
Contact information
Practice address
1181 BROADWAY, SUITE 5, CHULA VISTA, CA 91911-2749
(619) 585-0016
(619) 585-0410
Mailing address
1550 W. MCEWEN DRIVE, SUITE 500, FRANKLIN, TN 37067-1731
(615) 661-1100
(615) 507-3300
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
—
052835
BLUE CROSS OF CALIFORNIA
CA
05
—
CDC02835G
—
CA
01
—
ZZZR0214Z
BLUE SHIELD OF CALIFORNIA
CA
Enumeration date
11/17/2006
Last updated
02/10/2011
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