Agastya, Gautami
Agastya, Gautami is an sole proprietor health care provider with primary practice located at 652 W 11Th St Suite 137, Tracy CA 95376-3869. She recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as her primary health care specialty. Agastya, Gautami can be contacted via phone (209) 833-7555.Contact Information
Primary practice address
652 W 11Th St Suite 137
Tracy CA 95376-3869
Phone: (209) 833-7555
Fax: (209) 833-7518
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | C51385 | California |
Profile Details
| NPI number | 1356312516 |
|---|---|
| LBN Legal business name | Agastya, Gautami |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 27th, 2006 |
| Last updated | Jun 5th, 2013 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1356312516 | NPPES |
| California | MEDICAID | 00C513850 |
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