Manito Dialysis LLC

Primary specialty

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

License

550003385 Issued in CA

Legal business name

MANITO DIALYSIS LLC

Doing business as

Glendora Foothills Dialysis

Practice address

750 W Route 66 Ste Q
Glendora, CA 91740-4164

Phone

(626) 335-2063

Fax

(626) 914-1480

NPI assigned

Jul 16, 2014

Last updated

Dec 7, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Samuel T. Wey, AO

Title

VP, Licensure & Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Glendora Foothills Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

DaVita Glendora Foothills DialysisCCN 552785

Overall star rating

4.0 of 5

Ownership

Profit

Certified

Jun 6, 2016

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

24

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Total Renal Care Inc

  dba Cerritos Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Cerritos, CA
  • NPI 1255681011

  Member Of

  NPD member

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Minna F Huang, M.D.

  • Nephrology Physician
  • Upland, CA
  • NPI 1841447745
  NPD (past)

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Solomon Christopher Huang, M.D.

  • Nephrology Physician
  • Upland, CA
  • NPI 1184939381

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1405468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701907200000",
    "number": "1902213580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569",
            "telephone_number": "615-238-3085",
            "fax_number": "800-264-9682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 W ROUTE 66 STE Q",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917404164",
            "telephone_number": "626-335-2063",
            "fax_number": "626-914-1480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANITO DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-16",
        "last_updated": "2023-12-07",
        "certification_date": "2023-12-07",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "VP, LICENSURE & CERTIFICATION",
        "authorized_official_telephone_number": "615-341-6641",
        "authorized_official_credential": "AO"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "CA",
            "license": "550003385",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1902213580",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Glendora Foothills Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Glendora Foothills Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amy Elizabeth Maljian
• Lou Mallory
• Jefferey Mananguite
• Hector Mancillas
• Steven Marshall Mandell, DC
• Manmohan Kumar MD Inc
• Marina Mansour
• Tracy Lou Marcelino
• Maria Melissa Francisco, DDS, Inc.
• Myron C Mariano, M.D.

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Glendora, CA
• Providers in Glendora, 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 Dec 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.