Healthcare Provider Details

I. General information

NPI: 1346309614
Provider Name (Legal Business Name): GAYATHRI R VATSIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7516 W DESCHUTES PLACE
KENNEWICK WA
99336
US

IV. Provider business mailing address

7516 W DESCHUTES PLACE
KENNEWICK WA
99336
US

V. Phone/Fax

Practice location:
  • Phone: 509-783-8500
  • Fax: 509-783-5311
Mailing address:
  • Phone: 509-783-8500
  • Fax: 509-783-5311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberMD0021975
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: