Basic Information
| Provider Information | |||||||||
| NPI: | 1326030594 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SANTA FE COMMUNITY HEMODIALYSIS CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3810 KATELLA AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ALAMITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907203302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5625989399 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10012 NORWALK BLVD | ||||||||
| Address2: | |||||||||
| City: | SANTA FE SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906703345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629038281 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | EYMAN | ||||||||
| AuthorizedOfficialFirstName: | MALCOM | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5625982173 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0700X | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
ID Information
| ID | Type | State | Issuer | Description | CDC02724F | 05 | CA | MEDICAID |