Provider Demographics
NPI:1235254541
Name:QUOTIDIAN HOME DIALYSIS ORANGE COUNTY LLC
Entity Type:Organization
Organization Name:QUOTIDIAN HOME DIALYSIS ORANGE COUNTY LLC
Other - Org Name:HOME DIALYSIS CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATION
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHRABIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSC
Authorized Official - Phone:818-939-2047
Mailing Address - Street 1:511 S HARBOR BLVD
Mailing Address - Street 2:SUITE T
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-9374
Mailing Address - Country:US
Mailing Address - Phone:562-694-8520
Mailing Address - Fax:562-694-4911
Practice Address - Street 1:511 S HARBOR BLVD
Practice Address - Street 2:SUITE T
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-9374
Practice Address - Country:US
Practice Address - Phone:562-694-8520
Practice Address - Fax:562-694-8540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACDC52590FMedicaid
CA552590Medicare Oscar/Certification