Organization · Type 2 NPI

Davita Riverside LLC

End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Lake Elsinore, CA

NPI number 1205895869 Active

Practice location

32291 Mission Trl, Bldg S
Lake Elsinore, CA 92530-2310

Call (951) 674-5050 Map

Fax (951) 674-5570

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	240000841 (CA)

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

NPI record

NPI: 1205895869
Entity type: Organization (Type 2)
Issued: Mar 22, 2006
Last updated: Dec 24, 2024
Status: Active

Other names

<unavail>
Lake Elsinore Dialysis · doing business as
Lake Elsinore Dialysis · doing business as

Authorized official

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

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About NPI 1205895869

Davita Riverside LLC's National Provider Identifier is 1205895869, issued on Mar 22, 2006. The primary taxonomy on file is End-Stage Renal Disease (ESRD) Treatment Clinic/Center (261QE0700X), and the practice location is in Lake Elsinore, CA. The record was last updated on Dec 24, 2024.