Organization
CERRITOS DIALYSIS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GADSALLI RAMASWAMY RAVIKUMAR M.D. (PRESIDENT/CEO)
(714) 226-0818
Entity
Organization
Contact information
Practice address
19222 PIONEER BLVD, CERRITOS, CA 90703-6601
(562) 924-9990
(562) 924-9955
Mailing address
3356 W BALL RD, ANAHEIM, CA 92804-3702
(714) 226-0818
(714) 226-0700
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
930000982
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CDC02896F
—
CA
Enumeration date
07/18/2006
Last updated
11/29/2012
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