Provider Demographics
NPI:1710998380
Name:QUEEN'S DIALYSIS UNIT, INC.
Entity Type:Organization
Organization Name:QUEEN'S DIALYSIS UNIT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAUDIO
Authorized Official - Middle Name:H
Authorized Official - Last Name:GALLEGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-542-2900
Mailing Address - Street 1:1335 CYPRESS STREET
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3537
Mailing Address - Country:US
Mailing Address - Phone:909-542-2900
Mailing Address - Fax:909-592-6000
Practice Address - Street 1:1135 S SUNSET AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3937
Practice Address - Country:US
Practice Address - Phone:626-337-4245
Practice Address - Fax:626-480-0761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05-2868Medicare ID - Type UnspecifiedESRD