Healthcare Provider Details

I. General information

NPI: 1134189574
Provider Name (Legal Business Name): DAVITA NEPHROLOGY MEDICAL ASSOCIATES OF CALIFORNIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 05/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 MATLOCK RD SUITE 205
ARLINGTON TX
75243
US

IV. Provider business mailing address

PO BOX FILE #57025
LOS ANGELES CA
90074-0001
US

V. Phone/Fax

Practice location:
  • Phone: 817-375-0610
  • Fax: 817-375-0640
Mailing address:
  • Phone: 800-310-4872
  • Fax: 877-328-4923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY EFTHIM GABRIEL
Title or Position: OWNER PRESIDENT SECRETARY TREASURER
Credential: MD
Phone: 800-310-4872