Provider Demographics
NPI:1033264999
Name:POORSATTAR, GULNAR (MD)
Entity Type:Individual
Prefix:
First Name:GULNAR
Middle Name:
Last Name:POORSATTAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CAMARILLO RANCH RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-5901
Mailing Address - Country:US
Mailing Address - Phone:805-482-5550
Mailing Address - Fax:805-233-6367
Practice Address - Street 1:400 CAMARILLO RANCH RD
Practice Address - Street 2:SUITE 204
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-5901
Practice Address - Country:US
Practice Address - Phone:805-482-5550
Practice Address - Fax:805-233-6367
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50561207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C505610Medicaid
CA260051440OtherTAX ID #
CAW16155Medicare ID - Type Unspecified