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General NPI Number Information
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NPI Number | 1275719932
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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 | 01/12/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 125 CIRO AVE STE 110
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City | SAN JOSE
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State | CA
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Zip | 95128-1671
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Country | US
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Telephone | 408-885-0690
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Fax | 408-885-1503
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Provider Business Mailing Address
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Address Line | 125 CIRO AVE STE 110
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City | SAN JOSE
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State | CA
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Zip | 95128-1671
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Country | US
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Telephone | 408-885-0690
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Fax | 408-885-1503
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | ANTHONY E GABRIEL
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Credential | MD
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Telephone | 408-885-0690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | CA
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