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General NPI Number Information
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NPI Number | 1255576831
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Entity Type | Organization
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Legal Business Name | DAVITA NEPHROLOGY MEDICAL ASSOCIATES OF CA, INC.
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Dates
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Enumeration Date | 12/10/2008
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Last Update Date | 12/10/2008
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Provider Practice Location Address
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Address Line | PO BOX FILE # 57025
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City | LOS ANGELES
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State | CA
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Zip | 90074-0001
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Country | US
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Telephone | 303-626-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 650 EMPIRE ST
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City | FAIRFIELD
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State | CA
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Zip | 94533-5536
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Country | US
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Telephone | 707-426-5407
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Fax | 707-426-6376
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANTHONY GABRIEL
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Credential |
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Telephone | 303-626-6200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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