Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | A114878 | CA |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | A114878 | CA |
NPI | 1487731154 |
---|---|
Provider Name | Gaurav Mathur |
First Address | Lafayette, CA 94549-3717 |
Second Address | Oakland, CA 94609-3108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 23/11/2016 |