Provider Demographics
NPI:1710643168
Name:FRESENIUS MEDICAL CARE SAN BERNARDINO, LLC
Entity Type:Organization
Organization Name:FRESENIUS MEDICAL CARE SAN BERNARDINO, LLC
Other - Org Name:FRESENIUS KIDNEY CARE JUNIPER FONTANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:10557 JUNIPER AVE BUILDING A, SUITE B
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-7589
Mailing Address - Country:US
Mailing Address - Phone:808-854-4336
Mailing Address - Fax:909-574-1582
Practice Address - Street 1:10557 JUNIPER AVE BUILDING A, SUITE B
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92337-7589
Practice Address - Country:US
Practice Address - Phone:808-854-4336
Practice Address - Fax:909-574-1582
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-10
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment