Moreno Valley Regional Dialysis

Primary specialty

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

License

240000808 Issued in CA

Legal business name

MORENO VALLEY REGIONAL DIALYSIS

Practice address

22620 Goldencrest Drive
Suite 101
Moreno Valley, CA 92553-9032

Phone

(951) 656-3804

Fax

(951) 656-7508

NPI assigned

Sep 4, 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

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

{
    "created_epoch": "1188864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1353974400000",
    "number": "1740474683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3356 W BALL RD",
            "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": "22620 GOLDENCREST DRIVE",
            "address_2": "SUITE 101",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925539032",
            "telephone_number": "951-656-3804",
            "fax_number": "951-656-7508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MORENO VALLEY REGIONAL DIALYSIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-04",
        "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": "240000808",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Moreno Valley Dialysis Center
• Moreno Valley Imaging, L.L.C.
• Moreno Valley Med Care LLC
• Moreno Valley Medical Group, Inc
• Moreno Valley Physicians Associates, a Medical Corp
• Moreno Valley SL I Limited Partnership
• Moreno Valley SNF, LLC
• Moreno Valley Unified School District
• Moreno Valley Unified School District
• Moreno Valley Unified School District

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Moreno Valley, CA
• Providers in Moreno 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.