Provider Demographics
NPI:1982065108
Name:POMONA DIALYSIS CENTER, INC.
Entity Type:Organization
Organization Name:POMONA DIALYSIS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-542-2900
Mailing Address - Street 1:1335 CYPRESS ST STE 207
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3539
Mailing Address - Country:US
Mailing Address - Phone:909-542-2900
Mailing Address - Fax:909-592-6000
Practice Address - Street 1:255 E BONITA AVE
Practice Address - Street 2:BLDG 1, SUITE 200A
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1923
Practice Address - Country:US
Practice Address - Phone:909-542-2900
Practice Address - Fax:909-592-6000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment