Provider Demographics
NPI:1114091840
Name:RAI CARE CENTERS OF SOUTHERN CALIFORNIA II, LLC
Entity Type:Organization
Organization Name:RAI CARE CENTERS OF SOUTHERN CALIFORNIA II, LLC
Other - Org Name:RAI - MISSION GORGE - SAN DIEGO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:7007 MISSION GORGE RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-2422
Mailing Address - Country:US
Mailing Address - Phone:619-229-1070
Mailing Address - Fax:619-265-0409
Practice Address - Street 1:7007 MISSION GORGE RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-2422
Practice Address - Country:US
Practice Address - Phone:619-229-1070
Practice Address - Fax:619-265-0409
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZR0220ZOtherBLUE SHIELD OF CALIFORNIA
CA052779OtherBLUE CROSS OF CALIFORNIA
CACDC02779GMedicaid
CAZZZR0220ZOtherBLUE SHIELD OF CALIFORNIA
CA052779OtherBLUE CROSS OF CALIFORNIA