Organization
AVY, LLC
Active
Other names
Care Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREY TARASOV (MEMBER/MANAGER)
(310) 467-5197
Entity
Organization
Contact information
Practice address
1510 S CENTRAL AVE STE 140, GLENDALE, CA 91204-3857
(310) 467-5197
Mailing address
1510 S CENTRAL AVE STE 140, GLENDALE, CA 91204-3857
(310) 467-5197
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
03/16/2021
Last updated
04/17/2021
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