1922025857 NPI number — SAN ANWAR FAHMY GABRIEL MD

Table of content: SAN ANWAR FAHMY GABRIEL MD (NPI 1922025857)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922025857 NPI number — SAN ANWAR FAHMY GABRIEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GABRIEL
Provider First Name:
SAN
Provider Middle Name:
ANWAR FAHMY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GABRIEL
Provider Other First Name:
SAN
Provider Other Middle Name:
ANWAR FAHMY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922025857
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
864 E QUINCY AVE
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93720-2107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-708-0837
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1817 SHAW AVE STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLOVIS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93611-4069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-940-6664
Provider Business Practice Location Address Fax Number:
559-900-7236
Provider Enumeration Date:
07/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A95909 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00A959090 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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