Healthcare Provider Details

I. General information

NPI: 1063629962
Provider Name (Legal Business Name): ISH KUMAR GULATI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 PARTERRE CT
BAKERSFIELD CA
93311-9933
US

IV. Provider business mailing address

PO BOX 60128
BAKERSFIELD CA
93386-0128
US

V. Phone/Fax

Practice location:
  • Phone: 661-412-4785
  • Fax: 661-381-7374
Mailing address:
  • Phone: 661-412-4785
  • Fax: 661-381-7374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number35-094268
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: