Healthcare Provider Details

I. General information

NPI: 1639180300
Provider Name (Legal Business Name): VINAY CHANDRA GOWDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 12/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 SOQUEL AVE
SANTA CRUZ CA
95062-1323
US

IV. Provider business mailing address

2025 SOQUEL AVE
SANTA CRUZ CA
95062-1323
US

V. Phone/Fax

Practice location:
  • Phone: 831-458-5526
  • Fax: 831-423-1264
Mailing address:
  • Phone: 831-479-6603
  • Fax: 831-458-6293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA74884
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: