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General NPI Number Information
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NPI Number | 1689782484
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Entity Type | Organization
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Legal Business Name | GORADIA MEDICAL CORPORATION
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 6501 COYLE AVENUE ATTENTION: MEDICAL STAFF OFFICE, TUSHAR GORADIA MD
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City | CARMICHAEL
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State | CA
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Zip | 95608
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Country | US
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Telephone | 916-537-5000
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Fax | 916-534-1235
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Provider Business Mailing Address
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Address Line | 548 MARKET ST # 48710
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City | SAN FRANCISCO
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State | CA
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Zip | 94104-5401
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Country | US
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Telephone | 916-534-1234
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Fax | 916-534-1235
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. TUSHAR GORADIA
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Credential | MD, PHD
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Telephone | 916-534-1234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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