Alhambra Community Dialysis Unit, Inc.

Primary specialty

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

License

930000403 Issued in CA

Legal business name

ALHAMBRA COMMUNITY DIALYSIS UNIT, INC.

Practice address

2300 W Valley Blvd
Alhambra, CA 91803-1930

Phone

(626) 458-4726

Fax

(686) 289-8742

NPI assigned

Oct 23, 2006

Last updated

Mar 21, 2012By 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

Mr. Marino B De Peralta

Title

Vice President/Cfo

Phone

(626) 571-4596

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332288000000",
    "number": "1952484040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1840 S SAN GABRIEL BLVD",
            "city": "SAN GABRIEL",
            "state": "CA",
            "postal_code": "917763930",
            "telephone_number": "626-571-4596",
            "fax_number": "626-571-1706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 W VALLEY BLVD",
            "city": "ALHAMBRA",
            "state": "CA",
            "postal_code": "918031930",
            "telephone_number": "626-458-4726",
            "fax_number": "686-289-8742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALHAMBRA COMMUNITY DIALYSIS UNIT, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2012-03-21",
        "status": "A",
        "authorized_official_last_name": "DE PERALTA",
        "authorized_official_first_name": "MARINO",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "VICE PRESIDENT/CFO",
        "authorized_official_telephone_number": "626-571-4596",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "CA",
            "license": "930000403",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CDC02644F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD INSURANCE",
            "identifier": "ZZZ22373Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Alhambra, CA
• Providers in Alhambra, 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 Mar 21, 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.