Provider Demographics
NPI:1952601510
Name:LA QUINTA KIDNEY CENTER LLC
Entity Type:Organization
Organization Name:LA QUINTA KIDNEY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NARENDRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHANDRASHEKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-347-0707
Mailing Address - Street 1:43576 WASHINGTON ST
Mailing Address - Street 2:STE 101
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-8565
Mailing Address - Country:US
Mailing Address - Phone:760-200-1000
Mailing Address - Fax:760-200-2600
Practice Address - Street 1:43576 WASHINGTON ST
Practice Address - Street 2:STE 101
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-8565
Practice Address - Country:US
Practice Address - Phone:760-200-1000
Practice Address - Fax:760-200-2600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-29
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550001444261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA552673Medicare Oscar/Certification