Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | A91983 | CA |
NPI | 1366575003 |
---|---|
Provider Name | Alpana R Gowda |
First Address | Watsonville, CA 95076-3814 |
Second Address | Watsonville, CA 95076-3814 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 14/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A919831 | INDIVIDUAL PTAN (01) | CA |
A91983 | MED LICENSE # (01) | CA |
ZZZ23054Z | MEDICARE GROUP PTAN (01) | CA |