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General NPI Number Information
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NPI Number | 1629341060
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Entity Type | Organization
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Legal Business Name | DAVID J GAJDA MD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 02/15/2012
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Last Update Date | 02/20/2012
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Provider Practice Location Address
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Address Line | 111 RALEY BLVD # 240
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City | CHICO
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State | CA
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Zip | 95928-8351
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Country | US
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Telephone | 530-892-2020
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Fax | 530-898-9614
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Provider Business Mailing Address
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Address Line | 6283 CLARK RD SUITE #10
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City | PARADISE
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State | CA
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Zip | 95969-4100
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Country | US
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Telephone | 530-877-2020
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Fax | 530-877-4641
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID JEFFERY GAJDA
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Credential | MD
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Telephone | 530-877-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | G88865
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License Number State | CA
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