Basic Information
| Provider Information | |||||||||
| NPI: | 1689782484 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GORADIA MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 548 MARKET ST # 48710 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941045401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9165341234 | ||||||||
| FaxNumber: | 9165341235 | ||||||||
| Practice Location | |||||||||
| Address1: | 6501 COYLE AVENUE | ||||||||
| Address2: | ATTENTION: MEDICAL STAFF OFFICE, TUSHAR GORADIA MD | ||||||||
| City: | CARMICHAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9165375000 | ||||||||
| FaxNumber: | 9165341235 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | GORADIA | ||||||||
| AuthorizedOfficialFirstName: | TUSHAR | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9165341234 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MD, PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.