Healthcare Provider Details

I. General information

NPI: 1659459824
Provider Name (Legal Business Name): GAMINI D HETHUMUNI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 W LAS TUNAS DR STE 300
SAN GABRIEL CA
91776
US

IV. Provider business mailing address

1527 GLEN OAKS BLVD
PASADENA CA
91105
US

V. Phone/Fax

Practice location:
  • Phone: 626-281-1851
  • Fax: 626-281-9062
Mailing address:
  • Phone: 626-683-8301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA33433
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: