Provider Demographics
NPI:1548966930
Name:KIDNEY CARE OF BONITA SPRINGS LLC
Entity type:Organization
Organization Name:KIDNEY CARE OF BONITA SPRINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:FEDERICO
Authorized Official - Middle Name:
Authorized Official - Last Name:DUMENIGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-448-6261
Mailing Address - Street 1:4960 SW 72ND AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5549
Mailing Address - Country:US
Mailing Address - Phone:305-448-6261
Mailing Address - Fax:
Practice Address - Street 1:26381 S TAMIAMI TRL STE 122
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-7803
Practice Address - Country:US
Practice Address - Phone:239-388-7770
Practice Address - Fax:239-319-5826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment