Healthcare Provider Details

I. General information

NPI: 1669781282
Provider Name (Legal Business Name): JANHAVI R. GUDAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2010
Last Update Date: 12/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 S BASCOM AVE
SAN JOSE CA
95128-2604
US

IV. Provider business mailing address

PO BOX 54396 APT. B
SAN JOSE CA
95154-0396
US

V. Phone/Fax

Practice location:
  • Phone: 408-885-5611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA114100
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: