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General NPI Number Information
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NPI Number | 1033735931
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Entity Type | Organization
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Legal Business Name | GAURAV DATTA MD INC
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Dates
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Enumeration Date | 06/17/2020
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Last Update Date | 01/13/2023
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Provider Practice Location Address
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Address Line | 7510 FORTALEZA AVE
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City | ELK GROVE
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State | CA
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Zip | 95757-1769
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Country | US
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Telephone | 414-336-8677
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Fax | 925-954-6958
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Provider Business Mailing Address
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Address Line | 7510 FORTALEZA AVE
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City | ELK GROVE
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State | CA
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Zip | 95757-1769
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Country | US
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Telephone | 414-336-8677
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Fax | 925-954-6958
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Authorized Official
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Title or Position | OWNER
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Name | GAURAV DATTA
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Credential | MD
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Telephone | 414-336-8677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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