MEDICARE: DR. KATHY G GASPAR M.D.

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
1	207Q00000X	Family Medicine Physician	A93100	CA

General Provider Information

NPI Number	:	1699718833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHY G GASPAR M.D.

Provider Business Mailing Address
First Line	:	732 34TH ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-3822
Country	:	US
Telephone Number	:	916-278-6027
Fax Number	:	916-278-7359

Provider Business Practice Location Address
First Line	:	6000 J ST
Second Line	:	CSUS STUDENT HEALTH CENTER
City	:	SACRAMENTO
State	:	CA
Zip	:	95819-2605
Country	:	US
Telephone Number	:	916-278-6464
Fax Number	:	916-278-7359

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	03/13/2009

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