Provider Demographics
NPI:1386822088
Name:SATELLITE DIALYSIS OF ORANGE LLC
Entity Type:Organization
Organization Name:SATELLITE DIALYSIS OF ORANGE LLC
Other - Org Name:SATELLITE HEALTHCARE ORANGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/COO
Authorized Official - Prefix:
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-404-3600
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:714-285-9675
Mailing Address - Fax:650-625-6008
Practice Address - Street 1:1518 W LA VETA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4117
Practice Address - Country:US
Practice Address - Phone:714-285-9675
Practice Address - Fax:714-285-9681
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SATELLITE HEALTHCARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-05
Last Update Date:2023-01-17
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
CA550000808OtherCDPH
05D1085700OtherCLIA
CA1386822088Medicaid
CA552609Medicare Oscar/Certification