=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215315080
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALPANA GOWDA INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2015
-----------------------------------------------------
Last Update Date | 04/05/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 850 FREEDOM BLVD
-----------------------------------------------------
City | WATSONVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95076-3814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-319-4595
-----------------------------------------------------
Fax | 831-319-4597
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 850 FREEDOM BLVD
-----------------------------------------------------
City | WATSONVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95076-3814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-319-4595
-----------------------------------------------------
Fax | 831-319-4597
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICIAN
-----------------------------------------------------
Name | ALPANA GOWDA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 831-319-4595
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC28957
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208VP0000X
-----------------------------------------------------
Taxonomy Name | Pain Medicine Physician
-----------------------------------------------------
License Number | A91983
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | A91983
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------