Provider Demographics
NPI:1417069212
Name:SAN DIEGO DIALYSIS SERVICES, INC.
Entity Type:Organization
Organization Name:SAN DIEGO DIALYSIS SERVICES, INC.
Other - Org Name:FMC DIALYSIS SERVICES OF COLLEGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DIVITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:5961 UNIVERSITY AVE STE 317
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-6300
Mailing Address - Country:US
Mailing Address - Phone:619-229-9654
Mailing Address - Fax:619-286-0821
Practice Address - Street 1:5961 UNIVERSITY AVE STE 317
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-6300
Practice Address - Country:US
Practice Address - Phone:619-229-9654
Practice Address - Fax:619-286-0821
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2019-08-20
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
052886Medicare Oscar/Certification