Provider Demographics
NPI:1427668870
Name:DIALYSIS SPA, LLC
Entity type:Organization
Organization Name:DIALYSIS SPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:NAYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-615-1514
Mailing Address - Street 1:PO BOX 822206
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33082-2206
Mailing Address - Country:US
Mailing Address - Phone:305-615-1514
Mailing Address - Fax:305-501-4731
Practice Address - Street 1:2040 NE 163RD ST STE 206
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4953
Practice Address - Country:US
Practice Address - Phone:305-615-1514
Practice Address - Fax:305-501-4731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment