Healthcare Provider Details

I. General information

NPI: 1083887277
Provider Name (Legal Business Name): DHRUVIL PRADIP GANDHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 05/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2095 W VISTA WAY SUITE 106
VISTA CA
92083-6027
US

IV. Provider business mailing address

2095 W VISTA WAY SUITE 106
VISTA CA
92083-6027
US

V. Phone/Fax

Practice location:
  • Phone: 760-295-2924
  • Fax: 760-542-6382
Mailing address:
  • Phone: 760-295-2924
  • Fax: 760-542-6382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA103200
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberA 1032000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: