Provider Demographics
NPI:1326521436
Name:KIDNEY HEALTH SOLUTIONS LLC
Entity Type:Organization
Organization Name:KIDNEY HEALTH SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:ALFONZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-370-9720
Mailing Address - Street 1:11103 NW 7TH ST APT 103
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-3671
Mailing Address - Country:US
Mailing Address - Phone:786-370-9720
Mailing Address - Fax:305-448-6268
Practice Address - Street 1:11501 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3313
Practice Address - Country:US
Practice Address - Phone:786-370-9720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment