Provider Demographics
NPI:1114119500
Name:SOLANO DIALYSIS ACCESS CENTER, A PROFESSIONAL CORPORATION.
Entity Type:Organization
Organization Name:SOLANO DIALYSIS ACCESS CENTER, A PROFESSIONAL CORPORATION.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGTALUNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-841-4525
Mailing Address - Street 1:127 HOSPITAL DR
Mailing Address - Street 2:STE 102
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-2500
Mailing Address - Country:US
Mailing Address - Phone:707-643-9010
Mailing Address - Fax:707-643-9011
Practice Address - Street 1:127 HOSPITAL DR
Practice Address - Street 2:STE 102
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2500
Practice Address - Country:US
Practice Address - Phone:707-643-9010
Practice Address - Fax:707-643-9011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0106040OtherMEDICAL - GROUP
CAZZZ06222ZOtherMEDICARE - GROUP
CA=========OtherTAX ID