1700826039 NPI number — DAVITA NEPHROLOGY MEDICAL ASSOCIATES OF CALIFORNIA INC

Table of content: DR. JUSTIN TAYLOR LEWIS D.C. (NPI 1053710277)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700826039 NPI number — DAVITA NEPHROLOGY MEDICAL ASSOCIATES OF CALIFORNIA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVITA NEPHROLOGY MEDICAL ASSOCIATES OF CALIFORNIA 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:
1700826039
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX FILE # 57025
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90074-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-626-6239
Provider Business Mailing Address Fax Number:
866-917-5396

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4708 ALLIANCE BLVD
Provider Second Line Business Practice Location Address:
STE 770
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-626-6239
Provider Business Practice Location Address Fax Number:
866-917-5396
Provider Enumeration Date:
06/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GABRIEL
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
EFTHIM
Authorized Official Title or Position:
OWNER PRESIDENT SECRETARY & TREASUR
Authorized Official Telephone Number:
800-310-4872

Provider Taxonomy Codes

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

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





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