Provider Demographics
NPI:1871799882
Name:DIALYSIS CENTER OF COLTON, A CALIFORNIA GENERAL PARTNERSHIP
Entity type:Organization
Organization Name:DIALYSIS CENTER OF COLTON, A CALIFORNIA GENERAL PARTNERSHIP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-430-0930
Mailing Address - Street 1:600 N 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4905
Mailing Address - Country:US
Mailing Address - Phone:909-430-0930
Mailing Address - Fax:909-373-0428
Practice Address - Street 1:1275 W C ST
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1916
Practice Address - Country:US
Practice Address - Phone:909-430-0930
Practice Address - Fax:909-430-0934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACDC02817HMedicaid
05-2817Medicare ID - Type Unspecified