Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 2014022133 | MO |
Y | 207Q00000X | Family Doctor | A156322 | CA |
N | 207Q00000X | Family Doctor | RL11900 | ND |
NPI | 1003109448 |
---|---|
Provider Name | Gokul Budati |
First Address | Sacramento, CA 95827-2539 |
Second Address | Yuba City, CA 95991 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2011 |
Last Update Date | 24/10/2018 |