Healthcare Provider Details

I. General information

NPI: 1497946115
Provider Name (Legal Business Name): EUGENIO GOTARD AMPARO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

500 UNIVERSITY AVE
SACRAMENTO CA
95825-6504
US

IV. Provider business mailing address

500 UNIVERSITY AVE
SACRAMENTO CA
95825-6504
US

V. Phone/Fax

Practice location:
  • Phone: 916-830-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License NumberC41052
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2471C1101X
TaxonomyCardiovascular-Interventional Technology Radiologic Technologist
License NumberC41052
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2471N0900X
TaxonomyNuclear Medicine Technology Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: