Provider Demographics
NPI:1053071241
Name:GASTRO PHYSICIANS OF CALIFORNIA, INC.
Entity Type:Organization
Organization Name:GASTRO PHYSICIANS OF CALIFORNIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:X
Authorized Official - Credentials:MD
Authorized Official - Phone:209-751-7165
Mailing Address - Street 1:1658 CITADELLA DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-5022
Mailing Address - Country:US
Mailing Address - Phone:209-751-7165
Mailing Address - Fax:
Practice Address - Street 1:2288 AUBURN BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-1619
Practice Address - Country:US
Practice Address - Phone:209-751-7165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty