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NPI Code Detail

MEDICARE: GOPAL KRISHNARAO NAGASAMUDRAM MS, CCC-SPEECH PATHO

MEDICARE: GOPAL KRISHNARAO NAGASAMUDRAM MS, CCC-SPEECH PATHO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist40878CA

General Provider Information

NPI Number : 1386593176
Entity Type Code : Individual
Provider Name (Legal Business Name) : GOPAL KRISHNARAO NAGASAMUDRAM MS, CCC-SPEECH PATHO
Provider Business Mailing Address
First Line : 17800 US HIGHWAY 18
Second Line :
City : APPLE VALLEY
State : CA
Zip : 92307-1221
Country : US
Telephone Number : 760-552-6700
Fax Number :
Provider Business Practice Location Address
First Line : 17800 US HIGHWAY 18
Second Line :
City : APPLE VALLEY
State : CA
Zip : 92307-1221
Country : US
Telephone Number : 760-552-6700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2026
Last Update Date : 02/02/2026

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