Provider Demographics
NPI:1285828202
Name:PEGASUS DIALYSIS INCORPORATED
Entity Type:Organization
Organization Name:PEGASUS DIALYSIS INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIALYSIS ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CRUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:BARELA
Authorized Official - Suffix:JR
Authorized Official - Credentials:RN
Authorized Official - Phone:661-203-1435
Mailing Address - Street 1:1801 16TH ST
Mailing Address - Street 2:SUITE 'B'
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-5002
Mailing Address - Country:US
Mailing Address - Phone:661-326-8060
Mailing Address - Fax:661-326-1349
Practice Address - Street 1:3101 PEGASUS DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-6815
Practice Address - Country:US
Practice Address - Phone:661-203-1435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-03
Last Update Date:2007-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment