Organization · Type 2 NPI

Olive Dialysis LLC

End-Stage Renal Disease (ESRD) Treatment Clinic/Center · South Gate, CA

NPI number 1184004137 Active

Practice location

9848 Atlantic Ave
South Gate, CA 90280-5219

Call (323) 569-1035 Map

Fax (323) 569-1790

Mailing address

5200 Virginia Way, L&c Dept
Brentwood, TN 37027-7569

Specialties and licenses

Taxonomy	Code	License
End-Stage Renal Disease (ESRD) Treatment Clinic/Center Primary	261QE0700X	None listed

End-Stage Renal Disease (ESRD) Treatment Clinic/Center: Definition to come...

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NPI record

NPI: 1184004137
Entity type: Organization (Type 2)
Issued: Jun 4, 2015
Last updated: Aug 14, 2024
Status: Active

Other names

<unavail>
South Gate Dialysis · doing business as
South Gate Dialysis · doing business as

Authorized official

Samuel Wey
VP Licensure & Certification
(615) 341-6641

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1184004137

Olive Dialysis LLC's National Provider Identifier is 1184004137, issued on Jun 4, 2015. The primary taxonomy on file is End-Stage Renal Disease (ESRD) Treatment Clinic/Center (261QE0700X), and the practice location is in South Gate, CA. The record was last updated on Aug 14, 2024.