Healthcare Provider Details

I. General information

NPI: 1710401245
Provider Name (Legal Business Name): VENKATESH GONDHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 S AVENUE A
YUMA AZ
85364-7127
US

IV. Provider business mailing address

2400 S AVENUE A
YUMA AZ
85364-7170
US

V. Phone/Fax

Practice location:
  • Phone: 928-344-2000
  • Fax:
Mailing address:
  • Phone: 928-344-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number29980
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: