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General NPI Number Information
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NPI Number | 1659302891
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Entity Type | Individual
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Provider Name | VENKATESAN R GORANTLA M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 655 W 8TH ST FL CC6
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City | JACKSONVILLE
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State | FL
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Zip | 32209-6511
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Country | US
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Telephone | 513-310-2392
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Fax |
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Provider Business Mailing Address
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Address Line | 655 W 8TH ST FL CC6
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City | JACKSONVILLE
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State | FL
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Zip | 32209-6511
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Country | US
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Telephone | 513-310-2392
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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 | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | ME102628
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License Number State | FL
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