Provider Demographics
NPI:1538648407
Name:KIDNEY DOCTORS DIALYSIS CENTER INC
Entity Type:Organization
Organization Name:KIDNEY DOCTORS DIALYSIS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ADMINISTRATOR/DON
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:BERNAL PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP, FNP-C
Authorized Official - Phone:786-365-6624
Mailing Address - Street 1:12145 PEMBROKE RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-1727
Mailing Address - Country:US
Mailing Address - Phone:954-743-5804
Mailing Address - Fax:954-743-4747
Practice Address - Street 1:12145 PEMBROKE RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-1727
Practice Address - Country:US
Practice Address - Phone:954-743-5804
Practice Address - Fax:954-743-4747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-10
Last Update Date:2022-05-26
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
FL102376800Medicaid