Provider Demographics
NPI:1346062999
Name:PENINSULA DIALYSIS ACCESS CENTER
Entity type:Organization
Organization Name:PENINSULA DIALYSIS ACCESS CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMAHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-410-9266
Mailing Address - Street 1:91 WESTBOROUGH BLVD STE 1010
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-3196
Mailing Address - Country:US
Mailing Address - Phone:408-410-9266
Mailing Address - Fax:408-877-3786
Practice Address - Street 1:91 WESTBOROUGH BLVD STE 1010
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-3196
Practice Address - Country:US
Practice Address - Phone:408-410-9266
Practice Address - Fax:408-877-3786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-25
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical