Organization
KIDNEY DIALYSIS CENTER OF PISMO BEACH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA VIRAL UPPONI (DIRECTOR OF ACCOUNTS RECEIVABLE)
(805) 433-7506
Entity
Organization
Contact information
Practice address
320 JAMES WAY, SUITE # 110, PISMO BEACH, CA 93449-2813
(805) 556-0577
(805) 433-7655
Mailing address
PO BOX 940838, SIMI VALLEY, CA 93094-0838
(805) 433-7777
(805) 433-7655
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
05
—
CDC52556
—
CA
Enumeration date
06/19/2006
Last updated
07/30/2007
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