Provider Demographics
NPI:1114460359
Name:MONROVIA DIALYSIS FACILITY INC
Entity Type:Organization
Organization Name:MONROVIA DIALYSIS FACILITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HARESH
Authorized Official - Middle Name:MOHAN
Authorized Official - Last Name:KHILNANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-353-8525
Mailing Address - Street 1:51 N 5TH AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3711
Mailing Address - Country:US
Mailing Address - Phone:626-353-8525
Mailing Address - Fax:
Practice Address - Street 1:1930 WALKER AVE
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-4847
Practice Address - Country:US
Practice Address - Phone:626-353-8525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA050550261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment