Provider Demographics
NPI:1922025857
Name:GABRIEL, SAN ANWAR FAHMY (MD,)
Entity Type:Individual
Prefix:DR
First Name:SAN
Middle Name:ANWAR FAHMY
Last Name:GABRIEL
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:DR
Other - First Name:SAN
Other - Middle Name:ANWAR FAHMY
Other - Last Name:GEBRAIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD,
Mailing Address - Street 1:864 E QUINCY AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2107
Mailing Address - Country:US
Mailing Address - Phone:559-708-0837
Mailing Address - Fax:
Practice Address - Street 1:1180 E SHAW AVE
Practice Address - Street 2:SUIT 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7812
Practice Address - Country:US
Practice Address - Phone:559-228-4222
Practice Address - Fax:559-228-4299
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95909261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A959090Medicaid
CA00A959090Medicare PIN
CA00A959090Medicaid
CA00A959091Medicare PIN