Provider Demographics
NPI:1215523832
Name:DAVITA
Entity type:Organization
Organization Name:DAVITA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:LEIZYL
Authorized Official - Middle Name:ESTRADA
Authorized Official - Last Name:RACION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-205-1126
Mailing Address - Street 1:464 E YOSEMITE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-8489
Mailing Address - Country:US
Mailing Address - Phone:209-205-1126
Mailing Address - Fax:209-205-1130
Practice Address - Street 1:464 E YOSEMITE AVE STE B
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-8489
Practice Address - Country:US
Practice Address - Phone:209-205-1126
Practice Address - Fax:209-205-1130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WD1100XNursing Service ProvidersRegistered NurseDialysis, PeritonealGroup - Single Specialty
No251K00000XAgenciesPublic Health or WelfareGroup - Single Specialty