Healthcare Provider Details

I. General information

NPI: 1093649113
Provider Name (Legal Business Name): PRAAJNYA GOWDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 CAMINO DEL SUR
GOLETA CA
93117-7402
US

IV. Provider business mailing address

775 CAMINO DEL SUR
GOLETA CA
93117-7402
US

V. Phone/Fax

Practice location:
  • Phone: 818-877-5754
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: