Provider Demographics
NPI:1568172484
Name:RANCHO DIALYSIS CENTER INC
Entity Type:Organization
Organization Name:RANCHO DIALYSIS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GINA LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-542-2898
Mailing Address - Street 1:1335 CYPRESS ST STE 207
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3539
Mailing Address - Country:US
Mailing Address - Phone:909-542-2898
Mailing Address - Fax:
Practice Address - Street 1:7777 MILLIKEN AVE
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-6780
Practice Address - Country:US
Practice Address - Phone:909-542-2898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment