Provider Demographics
NPI:1003581927
Name:GAUTAM, SANGITA
Entity Type:Individual
Prefix:
First Name:SANGITA
Middle Name:
Last Name:GAUTAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13585 SAN PABLO AVENUE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806
Mailing Address - Country:US
Mailing Address - Phone:510-942-4600
Mailing Address - Fax:
Practice Address - Street 1:13585 SAN PABLO AVENUE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806
Practice Address - Country:US
Practice Address - Phone:510-230-8121
Practice Address - Fax:510-942-4601
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool