Healthcare Provider Details

I. General information

NPI: 1487699765
Provider Name (Legal Business Name): DAVITA NEPHROLOGY MEDICAL ASSOCIATES OF CALIFORNIA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 MCHENRY AVE SUITE 310
MODESTO CA
95350-4500
US

IV. Provider business mailing address

1832 CENTRE POINT CIR SUITE 106
NAPERVILLE IL
60563-1438
US

V. Phone/Fax

Practice location:
  • Phone: 209-492-9301
  • Fax: 209-492-9180
Mailing address:
  • Phone: 630-836-8724
  • Fax: 866-594-9002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTHONY E. GABRIEL
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 310-536-2615