Organization
ADVANCED HOME DIALYSIS, INC
Active
Organization
ADVANCED HOME DIALYSIS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELLA MASTOV (CEO)
(323) 327-8554
Entity
Organization
Contact information
Practice address
19231 VICTORY BLVD STE 103, RESEDA, CA 91335-6314
(323) 327-8554
Mailing address
19231 VICTORY BLVD STE 103, RESEDA, CA 91335-6314
(323) 327-8554
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
—
—
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
04/06/2022
Last updated
04/09/2026
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