Healthcare Provider Details

I. General information

NPI: 1265827802
Provider Name (Legal Business Name): GAUTAM NAGENDRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 BATH ST FL 2
SANTA BARBARA CA
93105-4324
US

IV. Provider business mailing address

PO BOX 689
SANTA BARBARA CA
93102-0689
US

V. Phone/Fax

Practice location:
  • Phone: 805-879-4240
  • Fax: 805-566-3037
Mailing address:
  • Phone: 805-879-4240
  • Fax: 805-566-3037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberA155780
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: