Provider Demographics
NPI:1457487738
Name:HOME DIALYSIS THERAPIES OF SAN DIEGO
Entity Type:Organization
Organization Name:HOME DIALYSIS THERAPIES OF SAN DIEGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:858-549-3400
Mailing Address - Street 1:10672 WEXFORD ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3969
Mailing Address - Country:US
Mailing Address - Phone:858-549-3400
Mailing Address - Fax:858-549-3405
Practice Address - Street 1:10672 WEXFORD ST
Practice Address - Street 2:SUITE 250
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-3969
Practice Address - Country:US
Practice Address - Phone:858-549-3400
Practice Address - Fax:858-549-3405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2009-08-03
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
CACDC52543FMedicaid
CACDC52543FMedicaid