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General NPI Number Information
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NPI Number | 1053071241
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Entity Type | Organization
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Legal Business Name | GASTRO PHYSICIANS OF CALIFORNIA, INC.
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Dates
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Enumeration Date | 12/29/2021
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Last Update Date | 12/29/2021
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Provider Practice Location Address
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Address Line | 2288 AUBURN BLVD STE 101
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City | SACRAMENTO
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State | CA
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Zip | 95821-1619
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Country | US
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Telephone | 209-751-7165
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Fax |
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Provider Business Mailing Address
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Address Line | 1658 CITADELLA DR
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City | ROSEVILLE
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State | CA
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Zip | 95747-5022
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Country | US
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Telephone | 209-751-7165
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. JONATHAN S DAVIDSON X
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Credential | MD
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Telephone | 209-751-7165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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