Organization · Type 2 NPI

Manito Dialysis LLC

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

NPI number 1902213580 Active

Practice location

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

Call (626) 335-2063 Map

Fax (626) 914-1480

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	550003385 (CA)

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

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NPI record

NPI: 1902213580
Entity type: Organization (Type 2)
Issued: Jul 16, 2014
Last updated: Dec 7, 2023
Status: Active

Other names

<unavail>
Glendora Foothills Dialysis · doing business as
Glendora Foothills Dialysis · doing business as

Authorized official

Samuel T. Wey, AO
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 1902213580

Manito Dialysis LLC's National Provider Identifier is 1902213580, issued on Jul 16, 2014. The primary taxonomy on file is End-Stage Renal Disease (ESRD) Treatment Clinic/Center (261QE0700X), and the practice location is in Glendora, CA. The record was last updated on Dec 7, 2023.