Provider Demographics
NPI:1023566312
Name:LAVITTA DIALYSIS CENTER, INC
Entity Type:Organization
Organization Name:LAVITTA DIALYSIS CENTER, INC
Other - Org Name:LAVITTA DIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA JULISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:939-325-6493
Mailing Address - Street 1:529 CALLE LUIS A MORALES
Mailing Address - Street 2:ESTANCIAS DEL GOLF
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-0531
Mailing Address - Country:US
Mailing Address - Phone:939-325-6493
Mailing Address - Fax:
Practice Address - Street 1:471 AVE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00733-0531
Practice Address - Country:US
Practice Address - Phone:939-325-6493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment