Organization
HACIENDA DIALYSIS CENTER, A MEDICAL CORP.
Active
Organization
HACIENDA DIALYSIS CENTER, A MEDICAL CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY SHIH (ADMINISTRATOR)
(626) 968-9558
Entity
Organization
Contact information
Practice address
2020 S HACIENDA BLVD, HACIENDA HEIGHTS, CA 91745-4265
(626) 968-9558
(626) 968-7787
Mailing address
2020 S HACIENDA BLVD, HACIENDA HEIGHTS, CA 91745-4265
(626) 968-9558
(626) 968-7787
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
930000972
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CDC02879F
—
CA
Enumeration date
11/04/2005
Last updated
02/19/2008
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