Provider Demographics
NPI:1306806740
Name:DAVITA NEPHROLOGY MEDICAL ASSOCIATES OF CA, INC.
Entity type:Organization
Organization Name:DAVITA NEPHROLOGY MEDICAL ASSOCIATES OF CA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-626-6220
Mailing Address - Street 1:650 EMPIRE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-5536
Mailing Address - Country:US
Mailing Address - Phone:707-426-5407
Mailing Address - Fax:707-426-6376
Practice Address - Street 1:650 EMPIRE ST
Practice Address - Street 2:SUITE A
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5536
Practice Address - Country:US
Practice Address - Phone:707-426-5407
Practice Address - Fax:707-426-6376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACJ5764OtherRAILROAD MEDICARE
CAZZZ27071ZMedicare PIN
CAZZZ21333ZMedicare ID - Type Unspecified