Provider Demographics
NPI:1700148632
Name:PROFESSIONAL DIALYSIS CENTER, LLC
Entity Type:Organization
Organization Name:PROFESSIONAL DIALYSIS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-417-1070
Mailing Address - Street 1:10021 PINES BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6194
Mailing Address - Country:US
Mailing Address - Phone:954-417-1070
Mailing Address - Fax:954-417-1071
Practice Address - Street 1:10021 PINES BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6194
Practice Address - Country:US
Practice Address - Phone:954-417-1070
Practice Address - Fax:954-417-1071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment