Healthcare Provider Details

I. General information

NPI: 1902970221
Provider Name (Legal Business Name): SANDEEP GUNTUR MD,MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 CLEMENT STREET
SAN FRANCISCO CA
94121
US

IV. Provider business mailing address

4150 CLEMENT STREET
SAN FRANCISCO CA
94121
US

V. Phone/Fax

Practice location:
  • Phone: 415-221-4810
  • Fax: 415-750-2249
Mailing address:
  • Phone: 415-221-4810
  • Fax: 415-750-2249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberA93358
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA93358
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: