1306806740 NPI number — DAVITA NEPHROLOGY MEDICAL ASSOCIATES OF CA, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306806740 NPI number — DAVITA NEPHROLOGY MEDICAL ASSOCIATES OF CA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVITA NEPHROLOGY MEDICAL ASSOCIATES OF CA, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306806740
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
650 EMPIRE ST
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94533-5536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-426-5407
Provider Business Mailing Address Fax Number:
707-426-6376

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
650 EMPIRE ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94533-5536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-426-5407
Provider Business Practice Location Address Fax Number:
707-426-6376
Provider Enumeration Date:
03/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GABRIEL
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
303-626-6220

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CJ5764 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com