Provider Demographics
NPI:1811917362
Name:HIGH DESERT HEMODIALYSIS, INC.
Entity type:Organization
Organization Name:HIGH DESERT HEMODIALYSIS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-265-7810
Mailing Address - Street 1:1007 W AVENUE M14
Mailing Address - Street 2:SUITE B
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-1443
Mailing Address - Country:US
Mailing Address - Phone:661-265-7810
Mailing Address - Fax:661-265-7089
Practice Address - Street 1:1007 W AVENUE M14
Practice Address - Street 2:SUITE B
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1443
Practice Address - Country:US
Practice Address - Phone:661-265-7810
Practice Address - Fax:661-265-7089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41776261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACDC02699FMedicaid
CA052699Medicare ID - Type Unspecified
CACDC02699FMedicaid