Provider Demographics
NPI:1376859108
Name:SATELLITE DIALYSIS OF LYNWOOD LLC
Entity Type:Organization
Organization Name:SATELLITE DIALYSIS OF LYNWOOD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE & RISK DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARGARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUIZAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-404-3771
Mailing Address - Street 1:300 SANTANA ROW
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2423
Mailing Address - Country:US
Mailing Address - Phone:562-674-2600
Mailing Address - Fax:650-625-6007
Practice Address - Street 1:8716 GARFIELD AVE
Practice Address - Street 2:STE 100
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-3723
Practice Address - Country:US
Practice Address - Phone:562-674-2600
Practice Address - Fax:562-928-9304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-31
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D2020393OtherCLIA CERTIFICATE OF WAIVER
CA1376859108Medicaid
CA550001699OtherSTATE LICENSE
CA05D2020393OtherCLIA CERTIFICATE OF WAIVER