Healthcare Provider Details

I. General information

NPI: 1194978338
Provider Name (Legal Business Name): DOUGLAS R. GADOWSKI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2008
Last Update Date: 08/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25775 MCBEAN PKWY SUITE 105
VALENCIA CA
91355-3702
US

IV. Provider business mailing address

25775 MCBEAN PKWY SUITE 105
VALENCIA CA
91355-3702
US

V. Phone/Fax

Practice location:
  • Phone: 661-255-2410
  • Fax: 661-255-8671
Mailing address:
  • Phone: 661-255-2410
  • Fax: 661-255-8671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberA22057
License Number StateCA

VIII. Authorized Official

Name: DR. DOUGLAS RAYMOND GADOWSKI
Title or Position: PRESIDENT
Credential: MD
Phone: 661-255-2410