Healthcare Provider Details

I. General information

NPI: 1154452837
Provider Name (Legal Business Name): GOURI PILLAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

742 W GARDENA BLVD
GARDENA CA
90247-5024
US

IV. Provider business mailing address

23430 HAWTHORNE BLVD BLDG 3, STE 210
TORRANCE CA
90505-4720
US

V. Phone/Fax

Practice location:
  • Phone: 310-802-6177
  • Fax: 310-802-6178
Mailing address:
  • Phone: 310-802-6177
  • Fax: 310-802-6178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA75744
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: