Healthcare Provider Details

I. General information

NPI: 1487731154
Provider Name (Legal Business Name): GAURAV MATHUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 HAWTHORNE AVE ROOM 2346
OAKLAND CA
94609-3108
US

IV. Provider business mailing address

3687 MT DIABLO BLVD SUITE 200
LAFAYETTE CA
94549-3717
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-8373
  • Fax: 510-869-8375
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberA114878
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA114878
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: