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General NPI Number Information
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NPI Number | 1508163908
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Entity Type | Organization
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Legal Business Name | GAURAV K GOSWAMI, M.D., INC.
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Dates
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Enumeration Date | 02/21/2011
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Last Update Date | 02/21/2011
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Provider Practice Location Address
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Address Line | 2284 N STATE COLLEGE BLVD
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City | FULLERTON
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State | CA
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Zip | 92831-1362
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Country | US
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Telephone | 714-990-4374
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Fax | 714-990-4376
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Provider Business Mailing Address
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Address Line | PO BOX 8755
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City | BREA
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State | CA
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Zip | 92822-5755
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Country | US
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Telephone | 714-990-4374
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Fax | 714-990-4376
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Authorized Official
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Title or Position | PRESIDENT
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Name | GAURAV K GOSWAMI
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Credential | M.D.
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Telephone | 714-990-4374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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