Healthcare Provider Details

I. General information

NPI: 1487798534
Provider Name (Legal Business Name): FERNANDO GAVIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13100 STUDEBAKER RD
NORWALK CA
90650-2531
US

IV. Provider business mailing address

PO BOX 25033
SANTA ANA CA
92799-5033
US

V. Phone/Fax

Practice location:
  • Phone: 562-868-3751
  • Fax: 562-929-3582
Mailing address:
  • Phone: 714-347-1010
  • Fax: 714-347-1082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA98156
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: