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General NPI Number Information
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NPI Number | 1386999175
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Entity Type | Individual
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Provider Name | GAGAN MATHUR MD, MBA
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Gender | Male
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Dates
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Enumeration Date | 07/17/2012
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Last Update Date | 03/14/2023
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Provider Practice Location Address
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Address Line | 101 THE CITY DR S
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City | ORANGE
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State | CA
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Zip | 92868-3201
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Country | US
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Telephone | 714-456-7002
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Fax |
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Provider Business Mailing Address
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Address Line | 200 S MANCHESTER AVE STE 300
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City | ORANGE
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State | CA
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Zip | 92868-3219
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Country | US
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Telephone | 714-456-2986
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number | MD-42245
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number | A170955
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207ZB0001X
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Taxonomy Name | Blood Banking & Transfusion Medicine Physician
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License Number | A170955
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License Number State | CA
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