Basic Information
| Provider Information | |||||||||
| NPI: | 1356549455 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIALYSIS CENTER OF ONTARIO LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 536 E. FOOTHILL BLVD, | ||||||||
| Address2: | |||||||||
| City: | UPLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099815882 | ||||||||
| FaxNumber: | 9099460833 | ||||||||
| Practice Location | |||||||||
| Address1: | 2850 INLAND EMPIRE BLVD STE C | ||||||||
| Address2: | |||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917644659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094762638 | ||||||||
| FaxNumber: | 9099460833 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2007 | ||||||||
| LastUpdateDate: | 12/13/2013 | ||||||||
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| AuthorizedOfficialLastName: | MAUNG | ||||||||
| AuthorizedOfficialFirstName: | HLA | ||||||||
| AuthorizedOfficialMiddleName: | MYINT | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9099815882 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0700X | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
No ID Information.