Healthcare Provider Details

I. General information

NPI: 1689036824
Provider Name (Legal Business Name): JAIMISH GWALANI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2016
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38437 MISSION BLVD STE 101
FREMONT CA
94536-4318
US

IV. Provider business mailing address

38437 MISSION BLVD STE 101
FREMONT CA
94536-4318
US

V. Phone/Fax

Practice location:
  • Phone: 510-806-1425
  • Fax: 510-768-8758
Mailing address:
  • Phone: 510-806-1425
  • Fax: 510-768-8758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberA151701
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: