| Gaurav Gandotra Inc | |
|
5900 Brockton Ave Riverside CA 92506-1862 | |
| (412) 478-9197 | |
| Not Available |
| Full Name | Gaurav Gandotra Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 5900 Brockton Ave, Riverside, California |
| Authorized Official Name and Position | Gaurav Gandotra (PRESIDENT) |
| Authorized Official Contact | 4124789197 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gaurav Gandotra Inc 5225 Canyon Crest Dr # 71-722 Riverside CA 92507-6301 Ph: (412) 478-9197 | Gaurav Gandotra Inc 5900 Brockton Ave Riverside CA 92506-1862 Ph: (412) 478-9197 |
| NPI Number | 1043856263 |
|---|---|
| Provider Enumeration Date | 11/22/2019 |
| Last Update Date | 11/22/2019 |
| Medicare PECOS PAC ID | 5597190553 |
|---|---|
| Medicare Enrollment ID | O20200121002400 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043856263 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Gaurav Gandotra |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1386617421 PECOS PAC ID: 0244261998 Enrollment ID: I20200121002342 |
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