Provider Demographics
NPI:1669436648
Name:DAVITA NEPHROLOGY MEDICAL ASSOCIATES OF CALIFORNA INC
Entity type:Organization
Organization Name:DAVITA NEPHROLOGY MEDICAL ASSOCIATES OF CALIFORNA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT SECRETARY TREASURER
Authorized Official - Prefix:MR
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 2355
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98401
Mailing Address - Country:US
Mailing Address - Phone:800-310-4872
Mailing Address - Fax:877-328-4923
Practice Address - Street 1:15141 E WHITTIER BLVD
Practice Address - Street 2:STE 225
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603
Practice Address - Country:US
Practice Address - Phone:562-698-3536
Practice Address - Fax:562-698-3945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
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
CAGR0093980Medicaid
CAGR0093980Medicaid