Provider Demographics
NPI:1700826039
Name:DAVITA NEPHROLOGY MEDICAL ASSOCIATES OF CALIFORNIA INC
Entity Type:Organization
Organization Name:DAVITA NEPHROLOGY MEDICAL ASSOCIATES OF CALIFORNIA INC
Other - Org Name:NORTH TEXAS KIDNEY CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT SECRETARY & TREASUR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:EFTHIM
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-310-4872
Mailing Address - Street 1:PO BOX FILE # 57025
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-0001
Mailing Address - Country:US
Mailing Address - Phone:303-626-6239
Mailing Address - Fax:866-917-5396
Practice Address - Street 1:4708 ALLIANCE BLVD
Practice Address - Street 2:STE 770
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:76093
Practice Address - Country:US
Practice Address - Phone:303-626-6239
Practice Address - Fax:866-917-5396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W577Medicare PIN