Fountain Valley Regional Dialysis Center LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

License

550001163 Issued in CA

Legal business name

FOUNTAIN VALLEY REGIONAL DIALYSIS CENTER LLC

Practice address

17150 Euclid Avenue
Suite 111
Fountain Valley, CA 92708-4092

Phone

(714) 966-1595

Fax

(714) 966-1555

NPI assigned

May 30, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Gadsalli Ramaswamy Ravikumar, M.D.

Title

President/Ceo

Phone

(714) 226-0818

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1353974400000",
    "number": "1265633747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3356 W BALL RD",
            "address_2": "SUITE 216",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928043702",
            "telephone_number": "714-226-0818",
            "fax_number": "714-226-0700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17150 EUCLID AVENUE",
            "address_2": "SUITE 111",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927084092",
            "telephone_number": "714-966-1595",
            "fax_number": "714-966-1555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNTAIN VALLEY REGIONAL DIALYSIS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-30",
        "last_updated": "2012-11-27",
        "status": "A",
        "authorized_official_last_name": "RAVIKUMAR",
        "authorized_official_first_name": "GADSALLI",
        "authorized_official_middle_name": "RAMASWAMY",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "714-226-0818",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "CA",
            "license": "550001163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fountain Valley Heallthcare Center
• Fountain Valley Hospitalist Medical Group
• Fountain Valley Integrative Physical Medicine
• Fountain Valley Office
• Fountain Valley Pediatrics, Inc.
• Fountain Valley Regional Hospital & Medical Center (Fountain Valley Regional Hospital)
• Fountain Valley Regional Hospital and Medical Center
• Fountain Valley Regional Sleep Center, LLC (HSD Sleep Center)
• Fountain Valley SD
• Fountain Valley Senior Homes LLC (Fountain Valley Senior Homes 2)

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Fountain Valley, CA
• Providers in Fountain Valley, CA by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.