MEDICARE: NUPUR KEYOOR GOSALIA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A122825	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GN186Z	OTHER	CA	MEDICARE PTAN

General Provider Information

NPI Number	:	1528223542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NUPUR KEYOOR GOSALIA MD

Provider Business Mailing Address
First Line	:	225 EAST SECOND AVENUE
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92025-4249
Country	:	US
Telephone Number	:	760-291-6700
Fax Number	:	760-737-7324

Provider Business Practice Location Address
First Line	:	3142 VISTA WAY STE 100
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-3627
Country	:	US
Telephone Number	:	760-291-6700
Fax Number	:	760-754-3859

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2008
Last Update Date	:	12/13/2024

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Directions to “ NUPUR KEYOOR GOSALIA MD” Practice Location

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