Provider Demographics
NPI:1487699765
Name:DAVITA NEPHROLOGY MEDICAL ASSOCIATES OF CALIFORNIA, INC
Entity type:Organization
Organization Name:DAVITA NEPHROLOGY MEDICAL ASSOCIATES OF CALIFORNIA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:E
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-536-2615
Mailing Address - Street 1:1832 CENTRE POINT CIR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-1438
Mailing Address - Country:US
Mailing Address - Phone:630-836-8724
Mailing Address - Fax:866-594-9002
Practice Address - Street 1:1524 MCHENRY AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4500
Practice Address - Country:US
Practice Address - Phone:209-492-9301
Practice Address - Fax:209-492-9180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ27071ZMedicare ID - Type Unspecified