Provider Demographics
NPI:1861580086
Name:COMMUNITY DIALYSIS CENTER LLC
Entity type:Organization
Organization Name:COMMUNITY DIALYSIS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURCIAGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-459-5959
Mailing Address - Street 1:4576 PASEO BRAZOS
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2375
Mailing Address - Country:US
Mailing Address - Phone:520-459-5959
Mailing Address - Fax:
Practice Address - Street 1:4525 CAMPUS DRIVE
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635
Practice Address - Country:US
Practice Address - Phone:520-459-5959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5215207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty